Gastric Disorders Flashcards by Indie Caldwell

What does the stomach secrete in response to its expansion during digestion?

hydrochloric acid, pepsin, gastrin

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Why do you need the stomach to have a low pH

kill ingested bacteria and promote proteolysis and activation of pepsin

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What type of cell does gastrin originate from

G cells

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What are the 2 purposes of gastrin

stimulate gastric juice (acidic - -.9-1.5) (hydrochloric acid, pepsin, and intrinsic factor

stimulate stomach motor function

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what is the pathway that leads to gastrin and its effect?

When food enters the stomach, the protein component stimulates G cells situated in the antral region of the stomach to release the hormone gastrin, which stimulates the cells to release histamine and stimulates parietal cells to secrete acid.

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As the acidity of the stomach and duodenum increases, protective feedback pathways are activated to inhibit further___ ___________.

acid secretion

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The release of what is a mechanism of acid-mediated inhibitory control

somatostatin by D cells

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Gastritis and gastritis related disease (gastric bcell lymphoma, peptic ulcer disease, and stomach cancer) are associated with what?

H. pylori

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when are you most likely to acquire H pylori

in childhood

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How do you contract H pylori

transmission via fecal/oral or oral/oral routes

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H pylori burrows and attaches to the gastric epithelium where pH is closer to what

4.5 to 6.5

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H pylori burrowing through mucus layer to gastric epithelium leads to inflammation resulting in histologic changes. This makes this cascade the _____ leading cause of cancer death worldwide

fifth

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Gold standard testing for H pylori

endoscopy with 4 biopsies along the stomach lining

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3 non invasive testing for H pylori

antibody test - not helpful in acute cases
Urea breath test - most widely used
Fecal antigen test

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How many times do you get a urea breath test

1st time: + –> treat –> 2nd time –> improvement?

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Symptoms of gastritis/dyspepsia

epigastric pain, discomfort, burning

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causes of acute gastritis

NSAIDs/Aspirin
Smoking and alcohol use
Physiological stress (burns, trauma, shock)

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Types of Chronic Gastritis

A (fundal) - autoimmune (atrophic gastritis or pernicious anemia)
B (astral) - helicobacter pylori infection

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What type of eating disorder can you often see gastritis with

Bulimia due to chronic vomiting

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What else besides vomiting can trigger gastritis

Excessive alcohol use and anti-inflammatory drugs

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What 4 things are most gastric and duodenal ulcers attributed

H pylori
NSAIDs
Severe physiologic stress
Hypersecretory conditions (Zollinger-Ellison)

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Why are NSAIDs implicated with Gastritis

They decrease prostaglandins which decreases mucus production resulting in gastric ulcers

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Patients with gastritis due to hypersecretory conditions present typically have what? and what do labs reveal?

a gastroma located in the pancreas or duodenum
present with diarrhea
labs reveal increased gastrin level

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What are gastronomas (gastrin secreting neuroendocrine tumor) associated with besides gastritis

Multiple endocrine neoplasia (MEN) type 1

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Treatment of Gastritis

PPI and removal of tumor

What two mechanisms contribute to the pathophysiology of gastritis?

H pylori Decrease in number of somatostatin secreting astral D cells

Is H pylori gram positive or gram negative

Gram negative

What does H pylori Produce

Ammonia which is toxic to epithelial cells, causing gastritis

How do you differentiate gastritis from peptic ulcer disease with patient presentations

patients with peptic ulcer disease tend to have symptoms more pronounced with food intake

What must you rule out on physical examination to make sure patient is not having complications (perforation) of peptic ulcer disease

rigid abdomen, rebound tenderness, or guarding

What type of patient presentations would you consider GERD until proven otherwise

complaint of heart burn or abdominal pain with heartburn more than once per week

If patient has any symptoms of dyspnea or chest pressure what should that make you think

cardiac etiology

Where does biliary pain often radiate and what type of food is it associated with

right shoulder fatty/greasy foods

If a patient describes a severe boring type of pain in epigastrium that is relieved when they bend over what should you be thinking?

pancreatitis

What are the alarm signs of dyspepsia

> 55 y/o bleeding anemia unintentional weight loss dysphagia odynophagia early satiety previous malignancy Lymphadenopathy abdominal mass previous ulcer

What alarm signs should be recognized in patients > 55 yo

unintended weight loss progressive dysphagia persistent vomiting evidence of GI bleeding family Hx of cancer

What 2 signs are patients with gastro ulcers always going to present with

dyspepsia and abdominal pain

What are other symptoms of gastro ulcers

pain in upper belly feeling bloated or early satiety decreased appetite nausea/vomiting vomiting blood or black colored stool more tired than usual - anemia

What is the most common cause of upper GI bleed

peptic ulcer disease

What will you see with Duodenal Ulcers

most common well nourished Pain 2-3 hours after meals EATING DECREASES PAIN

What will you see with Gastric Ulcers

Weight loss Pain 30 min-1hr after eating vomiting EATING INCREASES PAIN

How do you approach treatment and diagnosis for Peptic Ulcer Disease

Test then Treat (H Pylori Prevalence High) OR Empiric (H Pylori Prevalence Low)

How are you going to treat PUD if H Pylori prevalence is low

Empirically - PPI for 4-8 WEEKS no improvement? test for H Pylori

How are you going to treat PUD if H Pylori prevalence is high

Test for H Pylori then Treat Triple therapy (first line) - PPI, clarithromycin, amoxicillin for 14 d Quadruple Therapy (2nd line) - PPI, Bismuth, tetracycline, metronidazole

What are the most significant complications of PUD

gastric bleeding, perforation, or outlet obstruction

What is the most common cause of death in patients with PUD

Gastrointestinal bleeding... usually artery so bright red

What percentage of peptic ulcers cause perforation?

Where does perforation due to peptic ulcers usually occur

anteriorly through the duodenum or lesser curve of the stomach

How will patients present if they have a perforation due to peptic ulcer

fever, tachy, dehydration... the thorax will appear distended, tight, hyper resonant, and the patient does not want to be touched

What may you see on CXRay

Pneumoperitoneum free air under the diaphragm

What is another acute or chronic complication you can see with PUD

Gastric Outlet Obstruction

How will patients present with a Gastric Outlet Obstruction

Severe hypochloremic hypokalemic alkalosis this must be corrected prior to sx

motility disorder characterized by heartburn and caused by the reflux of gastric contents into the esophagus

Gastroesophageal reflux disease (GERD)

Patient presents with heartburn, generally worse after meals or lying down. Often already taken antacids ... they may also have regurgitation and dysphagia what are you thinking?

GERD

What is GERD caused by?

LES not closing allowing for reflux of gastric contents into esophagus causing burning pain

If you hear these 3 words in a vinet I immediately want you to think what Heartburn, dysphagia, regurgitation

GERD!!!!!

Exacerbating factors

Obesity or increased weight Fatty foods caffeine carbonated beverages ETOH tobacco drugs peppermints chocolate

How do you diagnose GERD

You can diagnose it with history alone usually

What will you hear in clinic from GERD patients

nongastro symptoms wheezing asthma exacerbation nocturnal cough or choking hoarseness Anemia enamel erosion halitosis

What must you also exclude if patient has chest pain before gastro evaluation

cardiac causes

If patient has ALARM symptoms or if they haven't improved on PPIs, what are you going to do

Endoscopy

What are you going to start GERD patients on

PPI

What are lifestyle modifications you can recommend to GERD patients

stop smoking lose weight avoid fatty foods, alcohol, coffee, chocolate elevate head of bed dont lie down after meal

What are pharmacological treatment options

PPI H2 blockers (tidine) Vitamin B12 and calcium supplementations if taking PPIs prolonged

What is the surgery option for treatment of GERD

Fundoplication

How should you treat GERD in pregnancy

antacid therapy, lifestyle modification, or sucralfate

History of chronic GERD which causes metaplastic change in the lining of the distal esophagus

Barrett Esophagus

What is Barrett esophagus associated with a risk for

adenocarcinoma of the esophagus

What population is Barrett Esophagus predominantly found in?

Middle aged white males

What are the risk factors for Barrett esophagus

long standing frequent reflux, smoking, male, older, central obesity

What do almost all Barrett Esophagus patients have

hiatal hernia

What is diagnostics for Barrett Esophagus

endoscopy

Treatment for Barrett Esophagus

PPIs, lifestyle modifications

Management of Barrett Esophagus with no Dysplasia and cancer risk

upper endoscopy every 3-5 years 0.2% per year

Management of Barrett Esophagus with LOW grade dysplasia and cancer risk

upper endoscopy annually OR endoscopic treatment with radio frequency ablation 0.7% per year, but may be as high as 8%

Management of Barrett Esophagus with HIGH grade dysplasia and cancer risk

radio frequency ablation 7-19% per year

What is the most common cancer/ gastric neoplasm of the stomach?

ADENOCARCINOMA

patient present with weight loss, early safety abdominal pain/fullness and dyspepsia what are you thinking

Adenocarcinoma of stomach

Are adenocarcinoma of the stomach patients usually asymptomatic

yes

Are males or females more likely to get adenocarcinoma

2x more common in males

What is the most important risk factor for gastric neoplasms

H pylori you may also see Virchow's node (above clavicle) or sister Mary joseph's node (belly button)

Projectile vomiting that occurs shortly after feeding an infant <3mo old

Pyloric Stenosis

What is the buzz word for the PANCE with Pyloric Stenosis

Olive like mass

Diagnostics for pyloric stenosis

ultrasound and/or barium studies

Gastric Disorders Flashcards

(84 cards)