Gastric Disorders 1

Question 1

GERD patho

Answer 1

LES barrier is breached and reflux of caustic gastric acid interacted with unprotected esophagus

Question 2

mechanisms that can cause reflux

Answer 2

1. loss of LES tone
2. increased frequency of relaxation
3. loss of secondary peristalsis after relaxation
4. increased stomach volume/pressure
5. increased acid production

Question 3

risk factors for GERD development

Answer 3

impaired LES tone (abnormal location, extrinsic compression)

extrinsic, increased pressure on intra abdominal organs

decreased acid cleaned

delayed gastric emptying/duodenalgastric reflux

hypersecreiton of acid

Question 4

hiatal hernia and GERD

Answer 4

causes deficient LES bc removes added constriction to diaphragmatic cura

more acid reflux, slow acid clearance, inflammation

Question 5

typical s/signs of GERD (5)

Answer 5

heartburn (after meals, received with antacid)

bitter regurgitation

increased salivation

chest and epigastric pain

dysphagia

Question 6

atypical symptoms

Answer 6

chronic cough, asthma, hoarseness, sore throat

Question 7

what exacerbated GERD symptoms

Answer 7

meals, bending or reclining/lying supine

Question 8

factors that worsen GERD

increase acid

Answer 8

fatty food
spicy food
acidic food/drink
bananas

Question 9

factors that worsen GERD

slow gastric emptying

Answer 9

TCA
anticholinergics
opioids

Question 10

factors that worsen GERD

lower LES pressure

Answer 10

nitroglycerine 
CCB
progesterone
benzos
alchol
opiods
chocolate 
coffee
pepperment

Question 11

diagnostic workup of GERD

Answer 11

presumptive diagnosis on clinical ground

six week trial of PPI or H2

endoscopy

Question 12

when do we preform endoscopy in GERD

Answer 12

1. doubt of diagnosis (alarm symptoms, persistent, erosive espohagitis)
2. men > 50 with chronic GERD (increased risk of esophageal cancer)

Question 13

complications of GERD

Answer 13

1. esophageal stricture
2. Barrett’s esophagus
3. esophageal ulcers
4. hemorrhage/perforation
5. fistula formation

Question 14

barrett’s esophagus

Answer 14

replacement of normal squamous epithelium with columnar epithelium

precursor of esophageal adenoma

Question 15

dyspepsia

Answer 15

EPIGASTRIC pain/burning
early salty
fullness after meal

Question 16

gastritis

Answer 16

inflammation associated with mucosal injury

Question 17

gastropathy

Answer 17

non inflammatory mucosal injury

Question 18

gastritis mc causes

Answer 18

nonspecific inflammation of mucosal surfaces

1. H. pylori
2. NSAIDs
3. stress related changes

can also be alcohol or atrophic

Question 19

h. pylori

Answer 19

gram negative rod found in gastric epithelium

60% of gastric,80% of duodenal ulcers

fecal orla

MC in low SES

Question 20

h. pylori pathophys

Answer 20

imbeds into mucosal layer and colonizes causing acute and chronic inflammation of gastric mucosa

produces large amounts of urease to break down acidic environment

increased risk of gastric adenocarcinoma and MALT lymphoma

Question 21

h. pylori urease

Answer 21

breaks down urea to alkaline ammonia and carbon dioxide

allows the immediate and surrounding areas to have a more neutral pH

Question 22

h. pylori gastritis

Answer 22

acute gastritis in antrum and then extends to entire mucosa (acute –> chronic)

may cause ulceration

Question 23

when is h. pylori detection performed

Answer 23

active PUD
early gastric CA/MALT lymphoma

CAN do IgG but unable to distinguish past or present infection

Question 24

h. pylori detection tests

Answer 24

1. urea breath test
2. stool antigen test
3. stomach biopsy

Question 25

urea breath test

Answer 25

pt drinks radioactive urea h. pylori urease will split the urea and detectable CO2 will be exhaled

Question 26

wat can give false negative on urea breath test?

Answer 26

PPI Abx bismouth UGIB

Question 27

stool antigen test

Answer 27

examine stool to look for h. pylori can document successful tx and presence NOT impacted by UGIB

Question 28

stomach biopsy

Answer 28

lining of stomach/small intestine taken during EGD and rapid urease test done false neg: PPI, ABX, bismuth, UGIB

Question 29

h. pylori triple therapy

Answer 29

10-14 days 1. proton pump inhibitor 2. Amoxicillin 3. Clarithromycin

Question 30

quadruple therapy h. pylori

Answer 30

10-14 days 1. PPI 2. Bismuth 3. Metronidazole 4. Tetracycline

Question 31

who gets quadruple h. pylori tx

Answer 31

resistance to clarithromycin or metronidazole | previous/recent metronidazole exposure

Question 32

NSAID gastritis

Answer 32

loss of prostaglandin/COX 1 to stimulate new mucosal formation AND loss of blood supply to mucosal wall (decreased vasodilation)

Question 33

risk factor of NSAID gastritis

Answer 33

duration of NSAID therapy increasing age, high NSAID dose, prior NSAID complication, concurrent steroid/anticoagulant/clopidigrel use

Question 34

how do NSAIDS cause gastritis?

Answer 34

DIRECT toxic effect (topical injury) INDIRECT effect (hepatic metabolite damage, decreased production of mucosal prostaglandin)

Question 35

prevention of NSAID gastritis

Answer 35

PPI/misoprostol can prevent BOTH gastric and duodenal ulcers H2 blockers can prevent duodenal ulcers

Question 36

alarm dyspepsia features

Answer 36

``` weight loss without cause, anorexia vomiting dysphagia anemia GI bleed abdominal mass FH of GI CA previous malignancy ```

Question 37

PUD

Answer 37

defect in GI mucosa of stomach or duodenum MC cause h. pylori infection and NSAIDS

Question 38

PUD s/s

Answer 38

Ulcer or acid dyspepsia (gnawing/burning pain, relieved with food) food provoked dyspepsia/indigestion (aggravated by food) reflux dyspepsia

Question 39

PUD diagnostic studies

Answer 39

empically tx with H2 blockers if mild >45, alarm symptoms = EGD + biopsy

Question 40

complications of PUD

Answer 40

GI bleed tachycardia/pallor outlet obstruction perforation