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Clin Med 3 > E1: PUD And Gastric CA > Flashcards

E1: PUD And Gastric CA Flashcards

(52 cards)

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1
Q

What do parietal cells do?

A

Produce HCL and intrinsic factor

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2
Q

What cells secrete pepsinogen?

A

Chief cells

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3
Q

What do mucous neck cells do?

A

Secrete a thin, acidic mucous

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4
Q

What do enteroendocrine cells do?

A

Secrete various hormones, enteroendocrine G cells secrete gastrin

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5
Q

What are the protective features of the stomach mucosa?

A
  • Bicarb rich mucus coating
  • tight junctions
  • stem cells where gastric glands joint gastric puts replace damaged mucosal cells
  • Stomach mucosa produces prostaglandins
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6
Q

What is it called when there is a defect in the gastric or duodenal mucosa that extends through the muscularis mucosa into the deeper laters of the wall?

A

Peptic ulcer disease

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7
Q

What are the risk factors for PUD?

A
  • Smoking
  • alcohol use
  • genetic
  • diet
  • psychological factors
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8
Q

What is the pathophysiology of PUD?

A

Not ulcers occur when the normal secretory, defense, or repair mechanisms of the stomach are disrupted by superimposed processes such as H pylori and ingestion of NSAIDs

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9
Q

What are the two main etiologies of PUD?

A
  • H pylori

- NSAIDs

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10
Q

What is the most common cause of PUD worldwide?

A

H pylori

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11
Q

H pylori infection increases the risk of ***.

A

Gastric cancer

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12
Q

What is the route of transmission of H pylori?

A

Oral-oral or fecal-oral

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13
Q

What kind of bacteria is H pylori?

A

Gram negative rod

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14
Q

What are the virulence factors of H pylori?

A

1) flagella
2) Urease
3) adhesins
4) causes inflammation

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15
Q

What does the flagella of H pylori do?

A

Used to burrow into the stomach mucous to reach epithelial cells, where it is less acidic

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16
Q

What does the urease of H pylori do?

A

Hydrolyze gastric urea to form ammonia, neutralize gastric acid, and produce a neutralized area around H pylori

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17
Q

What are the factors that increase risk of PUD with the use of NSAIDs?

A
  • Prior history of PUD/ulcer complications
  • H pylori infection
  • > 75 yo
  • increased dose, time, and duration
  • concomitant use of steroids, other NSAIDs, anticoagulants, aspirin, SSRIs, or alendronate
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18
Q

What are the common symptoms of PUD?

A
  • 70% are asymptomatic
  • upper abdominal pain
  • dyspepsia
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19
Q

A patient presents with abdominal pain that is worse after meals and lasts about 30 minutes to 1 hour afterwards. Patient has vomiting, hematemesis, weight loss, and anorexia.
What kind of ulcer are you suspicious of?

A

Gastric ulcer

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20
Q

Patient has abdominal pain that is relieved by meals, but becomes worse 2-3 hours after eating. Patient does not have any vomiting, but does have melena and weight gain.
What kind of ulcer are you suspicious of?

A

Duodenal ulcer

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21
Q

What are the alarm symptoms of PUD?

Study These Flashcards
A
  • Bleeding
  • Unexplained IDA
  • early satiety
  • unintentional weight loss
  • dysphagia
  • persistent vomiting
  • family hx of gastric cancer
22
Q

What are the possible complications of PUD?

Study These Flashcards
A
  • Bleeding (most common)
  • Perforation
  • penetration
  • gastric outlet obstruction
23
Q

What is the diagnosis and treatment of hemorrhage caused by PUD?

Study These Flashcards
A

Stabilize with IV fluids or PRBCs, Start IV PPI and perform EGD

24
Q

What is the clinical presentation of perforation caused by PUD?

Study These Flashcards
A

Sever, diffuse abdominal pain, tachycardia, weak pulse, nausea and vomiting

25
How is perforation caused by PUD diagnosed?
History and physical upright and abdominal XR Possibly CT
26
What is the treatment of perforation caused by PUD?
- Stabilize with IV fluids - NG tube, NG suction for gastric decompression - IV PPI - Broad spectrum abx - surgery
27
What is contraindicated if you suspect perforation?
UGI with barium
28
What happens in penetration caused by PUD?
The ulcer penetrates through the bowel wall without free perforation and leakage of luminal contents into the peritoneal cavity. -The pancreas is the most common adjacent structure affected
29
What is the clinical presentation of gastric outlet obstruction caused by PUD?
-Vomiting, early satiety, bloating, epigastric pain, weight loss, anorexia
30
What will you see on imaging in a patient with gastric outlet obstruction? What will you hear on abdominal auscultation?
Imaging: dilated bowel Auscultation: succussion splash
31
How is H pylori diagnosed? Which is most sensitive and specific?
- Biopsy for histology during EGD (most sensitive and specific!) - urea breath test - stool antigen test - serology
32
If a patient tests positive for H pylori, what should you do?
Treat and confirm eradication 4 weeks after completion of treatment. -Consider long term acid suppression with daily PPI
33
What is the clarithromycin triple therapy for h pylori?
- PPI BID - Clarithryomycin 500mg BID - Amoxicillin 1000mg BID All for 14 days
34
What is the Bismuth Quadruple therapy for H pylori?
- PPI BID - Bismuth subsalicylate 300mg QID - Metronidazole 250mg QID - Tetracycline 500mg QID
35
What is Zollinger -Ellison syndrome?
A syndrome in which gastrinomas, typically arising in the duodenum or pancreas, hypersecrete gastrin
36
What is the clinical presentation of ZES?
- Recurrent PUD, often distal to duodenal bulb - Upper abdominal pain - Diarrhea/steatorrhea
37
How is ZES diagnosed?
- fasting serum gastrin >1000 pg/mL and gastric pH <2 - secretion stimulation test - CT abdomen to localize tumor
38
What is a positive secretion stimulation test?
After IV secretin, gastrin levels increase by >200 pg/mL
39
What is the treatment of ZES?
PPIs and surgical resection if possible
40
What is the clinical presentation of gastric cancer, and what is the most common?
- Most patients are asymptomatic - weight loss - persistent abdominal pain - gastric ulcer history
41
90-95% of gastric cancers are ***.
Adenocarcinomas
42
How is gastric cancer diagnosed?
- EGD biopsy - UGI (second line) - staging
43
What may you see on EDG of a patient with gastric cancer?
-Subtle polypoid protrusion, a superficial plaque, mucosal discoloration, a depression, or an ulcer
44
What is Virchows node?
Enlarged supraclavicular lymph node associated with gastric cancer
45
What are the 3 lymph nodes associated with gastric cancer?
- Virchows node (most common) - Sister Mary Josephs node (periumbilical node) - Left axillary node (Irish node)
46
What is the treatment for early gastric cancer?
Endoscopic mucosal resection
47
What is the treatment for advanced gastric cancer?
Total or partial gastrectomy
48
What is the treatment for unresectable gastric cancers?
Chemotherapy vs chemoradiotherapy
49
What is dyspepsia?
Abdominal discomfort sometimes accompanied by bloating, belching, or abdominal distention
50
How should you work up a patient with dyspepsia who is >60 years old?
-EDG with biopsy. If PUD is present, treat accordingly. If no evidence of organic disease, consider functional dyspepsia and test for H pylori
51
How should you work up a patient with dyspepsia who is <60 years old?
Perform an EGD in patients with any of the following indications - significant weight loss - over GI bleeding - 3 or more alarm features - rapidly progressive alarm features
52
What are some of the dyspepsia alarm features?
Unintentional weight loss, progressive dysphagia, odynophagia, unexplained IDA, persistent vomiting, fhx of upper GI cancer

Clin Med 3 (17 decks)

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