Gastric Disorders

Question 1

2 disorders that cause injury of gastric mucosa are ________
disorder that causes injury of esophageal mucosa is ____________

Answer 1

injury of gastric mucosa: gastritis/peptic ulcer disease (PUD)
injury of esophageal mucosa: GERD

*these are separate diseases, they do NOT cause each other!

Question 2

parietal cells of the gastric lumen secrete HCl and ____

Answer 2

Intrinsic Factor, which protects vitamin B12 in acid environment

Question 3

prostoglandins help do what in the gut?

Answer 3

protect mucus lining

Question 4

what is the difference between gastritis and peptic ulcer disease and gastropathy

Answer 4

Gastritis is superficial inflammation of gastric mucosa with mucosal injury
Ulcer is penetration of the mucosa
Gastropathy: mucosal injury without inflammation

Question 5

most common cause of gastritis + other causes. common clinical presentation

Answer 5

#1 is H. pylori, other causes = NSAIDS, ASA, acute stress, alcohol
CP = most commonly AS
if sxs, epigastric pain, often described as “gnawing” and other similar sxs as PUD (vs acidic, burning, reflux pain like GERD)

Question 6

Gastric vs. duodenal ulcer pain response to food is …?

Answer 6

gastric usually pain with eating and duodenal is pain after eating

Question 7

hematemesis, melena suggest ______

Answer 7

hemorrhage, GI bleed

Question 8

any alarm signs need what for Dx ?

Answer 8

Urgent endoscopy in these patients to rule out perforation, gastric cancer or obstruction

Question 9

non-alarm sign but not getting better? …what will you do?

Answer 9

now is a good time to endoscope

Question 10

barium sticks to _____ or ______

Answer 10

ulcerated or inflamed tissue (makes it a good Dx test for these)

Question 11

what is the CLO test?

Answer 11

Campylobacter-like organism (CLO) test: Tissue biopsy and test for urease activity

*-Campylobactor is a Hpylori-like organism, these hydrolyze (split) the urea so that its detection means positive for these

Question 12

EGD endoscopy assesses _______, _______ and _______

Answer 12

bleeding, reflux and dysphagia

Question 13

erosive gastritis vs NSAID gastritis on EGD?

Answer 13

erosive: looks like mucosal inflammation
NSAID: “shotgun” pattern - little black spots of NSAIDs seen

Question 14

what is atrophic gastritis and where does it normally occur?

Answer 14

chronic inflammation of the gastric mucosa with loss of the gastric glandular cells and replacement by intestinal-type epithelium and fibrous tissue.
-decrease in glandular cells = loss of secretory mucosa
normally occurs in fundus and body

Question 15

atrophic gastritis may be related to _____, _____ or _______

Answer 15

alcohol, Hpylori, or Vit B12 deficiency (from decrease in intrinsic factor)

Question 16

atrophic gastritis may progress to _____

Answer 16

adenocarinoma (b/c it is a chronic inflammation issue)

Question 17

Xray of bowel perforation shows what?

Answer 17

FREE AIR UNDER DIAPHRAGM

Question 18

why can’t we use barium contrast if there is a possible bowel perforation? what can we use instead?

Answer 18

barium will stay in the gastric cavity for a while

- use water-soluble gastrograffin instead!

Question 19

what is a vagotomy and why does it work for gastritis/PUD?

Answer 19

removal of vagus nerve branch (to get rid of the Ach input that is causing the gastritis/PUD)

Question 20

heliobacter pylori formerly known as ________

Answer 20

campylobacter

Question 21

H. Pylori: colonizes….

hydrolyzes…

Answer 21

Colonizes gastric type mucosa. Is extremely sensitive to acid
Hydrolyzes urea to create a neutral pH for itself

Question 22

how is H pylori transmitted?

Answer 22

close human contact through oral-oral in industrialized world and fecal-oral in developing world, we think

Question 23

H. Pylori is NOT related to _____ or ______

Answer 23

Is NOT related to nonulcer dyspepsia or GERD

Question 24

what three tests will test for active H. pylori infection?

Answer 24

Non-invasive tests:
1). urea breath testing: 13C labeling of orally digesting urea and checking the lungs for excretion (as 13CO2)
2). stool antigen test
Invasive test is endoscopic tests where you take a biopsy sample and test it for H. pylori
*can use all three of these tests to confirm eradication after tx but stool antigen/urea breath prob more common

Question 25

Standard Txt for H pylori?

Answer 25

``` Quadruple therapy is best PPI Tetracycline Flagyl Bismuth subsalicylate for 14 days ```

Question 26

PPIs for H pylori, you must dose with what?

Answer 26

meal! (prior to meal)

Question 27

which are the worst offenders of NSAID-induced- ulcers? which one spares most prostaglandin production (and therefore is less likely a cause of this? )

Answer 27

worst: ASA | least offender: Cox2 inhibitors

Question 28

4 part Txt of NSAID ulcer

Answer 28

1. Stop the NSAID; use lowest possible dose for shortest possible time 2. Give: misoprostol, PPI, H-2 blocker 3. Switch to acetaminophen/COX-2 specific 4. Warn patients of the risk, Caution the use of combination products (e.g. Goody or B.C. powders, others)

Question 29

what is zollinger-ellison syndrome? MC site (and others). Common CP or index of suspicion

Answer 29

gastrin-secreting neuroendocrine tumor which leads to severe PUD and diarrhea, MC in duodenum (also seen in pancreas, lymph nodes) CP: pts with severe, multiple, recurrent ulcers + diarrhea

Question 30

how to dx and txt zollinger-ellison syndrome. what is the most common site of metastasis?

Answer 30

Dx: Best screening = elevated fasting gastrin levels (>1000) and confirm this with a secretin test (which causes severe increase in gastrin after administration) Tx: Surgery to locally resect, if metastatic or unable to resect then med management with lifelong high dose PPIs *MC site of metastasis is liver and associated lymph nodes

Question 31

what is gastroparesis

Answer 31

an autonomic neuropathy (usually mediated in walls of GI). You're not getting the big contractions that you need for digestion.

Question 32

gastroparesis is common in what pts? what are the signs?

Answer 32

DM; early satiety or post-prandial nausea

Question 33

Relapse rates for treated ulcers are ______; suspect ________ if relapse occurs

Answer 33

low | NSAIDS/OTC meds

Question 34

how to diagnose and tx gastritis?

Answer 34

dx: H. pylori testing, UGD with biopsy is test of choice tx: eradicate h. pylori with quad therapy if needed, PPI or H2 blocker to suppress acid or prophylaxis for stress gastritis, prevention of cause (like meds)

Question 35

which type of ulcer is more common in PUD? which ulcer type is more likely to progress into malignancy?

Answer 35

duodenum more common and often younger pts, while gastric is more likely to become malignant (4% turn to gastric adenocarcinoma) and usually presents in older pts

Question 36

PP behind duodenal vs gastric ulcers. what are the most common causes for PUD?

Answer 36

duodenal: increase in aggressive factors (H. Pylori, HCl) gastric: decrease in protective factors (mucus, bicarbonate, prostaglandins) * causes SAME as as gastritis: H. pylori (MC), NSAIDS/ASA more likely gastric ulcers, ETOH, smoking, stress PLUS zollinger-ellison syndrome

Question 37

CP for PUD and perforated ulcer

Answer 37

dyspepsia (burning, gnawing epigastric pain), N/V, duodenal (pain after eating) vs gastric (pain with eating), bleeding ulcer presents with hematemesis or melena Perforated ulcer: sudden onset severe abd pain plus peritoneal signs (rebound tenderness, guarding and rigidity)

Question 38

what is the most common cause of GI bleed?

Answer 38

PUD

Question 39

how do you dx PUD?

Answer 39

UGD with biopsy is TOC (best to diagnose H. pylori infection as well)

Question 40

tx for PUD? what does this depend on?

Answer 40

tx depends on H. Pylori status if +, then tx infection refractory to medical therapy, can do surgical approaches of vagotomy or Bilroth II (partial gastrectomy)

Question 41

when do you use EGD vs non-invasive tests to diagnose H. pylori?

Answer 41

if a patient doesn't need an EGD (more likely gastritis) then do one of the other two tests first

Question 42

all gastric ulcers need what repeat imaging to confirm healing?

Answer 42

repeat EGD, even if AS

Question 43

what is pyloric stenosis, what does it lead to, and it is the MC cause of what in infants?

Answer 43

hypertrophy and hyperplasia of pyloric sphincter which causes functional outlet obstruction MC cause of intestinal obstruction in infants

Question 44

CP and PE for pyloric stenosis

Answer 44

CP: non-bilious projectile vomiting especially after feeding, maybe dehydration or weight loss PE: olive shaped nontender abdominal pass

Question 45

Dx, labs and Tx for pyloric stenosis

Answer 45

Dx: US shows enlongated, thickened pylorus (initial test), Upper GI series shows "string sign" (barium passing through thickened pylorus) Labs: hypokalemic and hypochloremic metabolic alkalosis Tx: rehydration (IV fluids) and electrolyte repletion first, pyloromyotomy definitive

Question 46

MC type of gastric carcinoma, MC risk factor and others

Answer 46

MC type: adenocarcinoma (90%) | H. pylori is biggest RF, also smoking, preserved foods, chronic atrophic gastritis, and NHL

Question 47

CP of gastric carcinoma

Answer 47

* Most are advanced at presentation* | - weight loss and persistent abdominal pain , early satiety, hematemesis/melena

Question 48

how to dx and tc gastric carcinoma

Answer 48

dx: EGD with biopsy is initial test of choice tx: endoscopic resection for early local dz, +/- chemo/radiation

Question 49

which lymph node is commonly enlarged or should be examined if gastric cancer is suspected?

Answer 49

left supraclavicular node (virchow's node)

Question 50

what is the triple therapy tx of H pylori?

Answer 50

PPI, clarithromycin, and amoxicillin