Diseases of the Stomach and Duodenum Flashcards Preview

Gastroenterology > Diseases of the Stomach and Duodenum > Flashcards

Flashcards in Diseases of the Stomach and Duodenum Deck (47):
1

Common complaint with disorders of the stomach

Dyspepsia

2

inflammatory changes in the gastric mucosa

gastritis

3

Common causes for erosive and hemorrhagic gastritis conditions

stress, NSAIDs, and alcohol, portal hypertension

4

What are contributors for nonerosive, nonspecific gastritis?

H. pylori, pernicious anemia, eosinophilic gastritis

5

Symptoms include: anorexia, epigastric pain, N/V, and upper GI bleeding

erosive or hemorrhagic gastritis

6

What symptoms are associated with upper GI bleeding?

melena, coffee ground emesis, blood w/nasogastric suction

7

What is included in the work-up of an upper GI bleed?

CBC, serum Fe, upper endoscopy

8

How soon might stress gastritis occur in a critically ill patient?

within 72 hrs of admission

9

Treatment for GI bleeding secondary to stress induced gastritis

IV PPI bolus followed by continuous infusion
Sucralfate suspension given orally

10

What subtype of NSAIDs have a lower incidence of significant ulcer formation?

Cox-2 inhibitors

11

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

12

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

13

Due to excessive ETOH consumption. Symptoms include dyspepsia, nausea, emesis, minor hematemesis

Alcoholic Gastritis

14

Treatment for alcoholic gastrititis

H2 blockers or PPIs and sucralfate 2-4 weeks

15

Treatment for portal hypertensive gastropathy

propranolol or nadolol

16

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

17

Most common location for gastric ulcers

antrum

18

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

19

What are the two most common etiologies of peptic ulcers?

NSAIDs and chronic H.pylori infection

20

Clinical presentation includes: dyspepsia, periodic pain in epigastric region relieved w/food or antacids, sometimes nocturnal pain

peptic ulcers

21

Physial exam is often normal. Might be epigastric tenderness w/deep palpation. FOBT or FIT may be positive

peptic ulcers

22

Test of choice for the work-up of peptic ulcers

upper endoscopy

23

What type of imaging is needed if ulcer perforation is suspected?

abdominal CT

24

What are the primary pharmacological medications for peptic ulcer disease?

PPIs and H2 blockers

25

What are the second line agents to enhance mucosal defenses in peptic ulcer disease?

bismuth, misoprostol, and antacids

26

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.

27

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

28

Drug that should be avoided with H2 blockers

Cimetidine

29

Causes 75-90% of duodenal ulcers. Associated with increased gastric acid secretion. fecal-oral spread. Increases risk of gastric cancer

h. pylori infection

30

Combination therapy for H.pylori eradiaction

2-3 antibiotics + PPI or bismuth (“Triple or Quadruple Therapy”)

31

Treatment after triple or quadruple therapy for ulcers

Small ulcer (<1 cm) no further treatment. Large or complicated ulcer
continue PPI for up to 6 weeks

32

When should a patient be retested for H.pylori?

> 4 weeks post antibiotic therapy and > 2 weeks post discontinuation of PPI

33

Gastrin secreting gut neuroendocrine tumor. Causes hypergastrinemia from increase acid secretion

Zollinger-Ellison Syndrome (Gastrinoma)

34

Where are most tumors located in Zollinger-Ellison Syndrome (Gastrinoma)?

duodenal wall (45%)

35

Cinical presentation includes: dyspepsia, peptic ulcers, diarrhea/steatorrhea/weight loss if pancreas affected

Zollinger-Ellison Syndrome (Gastrinoma)

36

What is the best imaging study to find tumors associated with Zollinger-Ellison Syndrome (Gastrinoma)?

SPECT: Somatostatin receptor scintigraphy (SRS)

37

Delayed gastric emptying in the absence of a mechanical obstruction

gastroparesis

38

Common causes of gastroparesis

1-idiopathic (~50%), post-op, DM

39

Which type of DM patient is more likely to experience gastroparesis?

type 1

40

What are two viruses that may cause gastroparesis?

norwalk and rotavirus

41

Symptoms include: N/V, early satiety, bloating, upper abdominal pain

gastroparesis

42

What are the dietary modifications to help treat gastroparesis?

small meals 4-5x, low fat, avoid insoluble fiber/ETOH/carbonation/tobacco

43

Name the prokinetics used to treat gastroparesis

Metaclopramide and Macrolide antibiotics

44

Prokinetic that is used as a liquid formulation 15 min prior to eating. serious drug interactions that can lead to irreversible tardive dyskinesia. 12 week prescription with 2 week holiday

Metoclopramide

45

Prokinetic that induces gastric contraction and stimulates fundic contractility. Liquid formulation 40-250mg TID. Use no longer than 4 weeks

Erythromycin

46

First line antiemetic for persistant N/V caused by gastroparesis

Diphenhydramine 12.5mg po q 6-8 hrs

47

Surgical treatment for refractory cases of gastroparesis

Gastrostomy tube for decompression and jejunostomy for feeding