Flashcards in Diseases of the Stomach and Duodenum Deck (47)
Common complaint with disorders of the stomach
inflammatory changes in the gastric mucosa
Common causes for erosive and hemorrhagic gastritis conditions
stress, NSAIDs, and alcohol, portal hypertension
What are contributors for nonerosive, nonspecific gastritis?
H. pylori, pernicious anemia, eosinophilic gastritis
Symptoms include: anorexia, epigastric pain, N/V, and upper GI bleeding
erosive or hemorrhagic gastritis
What symptoms are associated with upper GI bleeding?
melena, coffee ground emesis, blood w/nasogastric suction
What is included in the work-up of an upper GI bleed?
CBC, serum Fe, upper endoscopy
How soon might stress gastritis occur in a critically ill patient?
within 72 hrs of admission
Treatment for GI bleeding secondary to stress induced gastritis
IV PPI bolus followed by continuous infusion
Sucralfate suspension given orally
What subtype of NSAIDs have a lower incidence of significant ulcer formation?
What should be ordered if a patient presents with dyspepsia and any of the following symptoms: severe pain, weight loss, vomiting, GI bleeding, anemia?
upper endoscopy-these are red flags
What is the treatment for a patient who presents with dyspepsia and no associated red flags?
discontinue NSAIDs, trial PPI 2-4wks. If no improvement, endoscopy referral
Due to excessive ETOH consumption. Symptoms include dyspepsia, nausea, emesis, minor hematemesis
Treatment for alcoholic gastrititis
H2 blockers or PPIs and sucralfate 2-4 weeks
Treatment for portal hypertensive gastropathy
propranolol or nadolol
Break in the gastric or duodenal mucosa >5mm in diameter and extend through muscularis mucosae. Can be caused by too much acid or pepsin
Peptic ulcer disease
Most common location for gastric ulcers
What is the difference between duodenal ulcers and gastric ulcers in terms of their age distribution at presentation?
duodenal ulcers more common btw 30-55yrs and gastric ulcers are more common btw 55-70 yrs
What are the two most common etiologies of peptic ulcers?
NSAIDs and chronic H.pylori infection
Clinical presentation includes: dyspepsia, periodic pain in epigastric region relieved w/food or antacids, sometimes nocturnal pain
Physial exam is often normal. Might be epigastric tenderness w/deep palpation. FOBT or FIT may be positive
Test of choice for the work-up of peptic ulcers
What type of imaging is needed if ulcer perforation is suspected?
What are the primary pharmacological medications for peptic ulcer disease?
PPIs and H2 blockers
What are the second line agents to enhance mucosal defenses in peptic ulcer disease?
bismuth, misoprostol, and antacids
How soon are 90% of duodenal and gastric ulcers healed after PPI therapy has been initiated?
duodenal ulcers in 4 weeks.
gastric ulcers in 8 weeks.
How soon are 85-90% of duodenal ulcers and gastric ulcers healed after initiation of H2 blocker therapy?
duodenal ulcers at 6 weeks. gastric ulcers at 8 weeks
Drug that should be avoided with H2 blockers
Causes 75-90% of duodenal ulcers. Associated with increased gastric acid secretion. fecal-oral spread. Increases risk of gastric cancer
h. pylori infection