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Gastrointestinal STEP 2 > Gastritis, ulcer, non-ulcer dyspepsia > Flashcards

Gastritis, ulcer, non-ulcer dyspepsia Flashcards

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1
Q

gastritis - defnition

A

inflammation or erosion of the gastric lining that is sometimes called gastropathy

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2
Q

gastritis - is caused by

A
  1. alcohol 2. NSAID 3. H. pylori 4. Porta hypertension

5. Stress (burns, trauma, sepsis, multiorgan failure, uremia)

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3
Q

atrophiuc gastritis is associated with

A

vit B12 deficiency

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4
Q

gastritis often presents with

A

GI bleeding without pain. Severe erosive gastritis can present with epigastric pan
- NSAID or alcoholsim in the history is a clue

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5
Q

gastritis - physical findings

A

there are no unique physical findings for gastritis

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6
Q

gastritis - bleeding

A

almost any degree: from mild cofee-graound emesis to large vomiting to red blood , to black stool (melena)

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7
Q

corellation of manifestations with volume of bleeding

A

cofee-ground emesis: 5-10 ml
heme (quaic) positive stool: 5-10 ml
melena: 50-100 ml

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8
Q

Gastritis - definitive diagnosis

A

only with upper endoscopy

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9
Q

Gastritis - anemia - diagnosis

A

no specific blood tests

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10
Q

Gastritis - radiologic studies

A

such as uppe GI series are NOT SPECIFIC ENOUGH

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11
Q

gastritis - capsule endoscopy

A

not appropriate for upper GI bleeding if endoscopy is one of the choices

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12
Q

in gastritis, also test fo

A

H. pylori –> this organism should be treated if it is associated with gastritis

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13
Q

tests for H. pylori - types (which is the most accurate)

A
  1. endoscopic biopsy (The most accurate)
  2. serology
  3. Urea C13 or C14 breath testing
  4. H. pylori stool antigen
    If endoscopy, there is no point in doing other test
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14
Q

H. pylori - endocopic biopsy - advantages

A

The most accurate test for H. pylori

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15
Q

H. pylori - endocopic biopsy - disadvantages

A

invasive

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16
Q

H. pylori - serology - advantages

A
  1. low cost
  2. easily excludes infection if it is negative
  3. no complications ore procedures required
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17
Q

H. pylori - serology - disadvantages

A

Low specificity –> a (+) test does not easily tell difference between current and previous infection

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18
Q

H. pylori - Urea C13 or C14 breath - advantages

A
  1. (+) only in active infection

2. non-invasive

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19
Q

H. pylori - Urea C13 or C14 breath - disadvantages

A

requires expensive equipment in office

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20
Q

H. pylori - stool antigen - advantages

A
  1. (+) only in active infection

2. non-invasive

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21
Q

H. pylori - stool antigen - disadvantages

A

Requires stool sample

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22
Q

gastritis - treatment

A

treat with PPI

H2 blockers, sucralfate and liquid anntiacids are not as effective

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23
Q

Sucralfate inert substance (aluminium hydroxide complex) that coats stomach

A 
inert substance (aluminium hydroxide complex) that coats stomach
NEVER CORRECT
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24
Q

stress ulcer prophylaxis is indicated in

A
  1. mechanical ventilation
  2. Burns
  3. Head trauma
  4. Coagulopathy
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25
how to distinguish definitely gastric and duodenal ulcers
no way wothout endoscopy
26
Peptic ulcer disease (PUD) is most commonly caused by
H. pylori
27
2nd MCC of PUD
NSAID: inhibition of the production of the protective mucus barrier in the stomach (inhibit prostagladins which produce mucus)
28
Less common causes of PUD
1. Burns 2. Head trauma 3. CROHN DISEASE 4. gastric cancer 5. Gastrinoma (Zollinger-Ellison syndrome)
29
alcohol and tobacco - PUD
they do not cause --> but they delay the healing
30
PUD - presentation
- recurrent episodes of epigastric pain hat is described as dull, sore, gnawing - Bleeding - tenderness and vomiting are UNUSUAL CANNOT ANSWER PUD BASED ONLY ON SYMPTOMS
31
PUD - bleeding?
although is the MCC of upper GI bleeding, the majority of ulcers do not bleed
32
PUD - tenderness and vomiting
unusual
33
duodenal vs gastric ulcers regarding sympoms
- duodenal is more often improved with eating - gastric is more often worsened by eating YOU CANNOT definitively distinguish duodenal, gastric and non ulcer dysplasia without endoscopy
34
PUD - diagnosis
there is no way to diagnose withou endoscopy or barium studies
35
PUD - most accurate tests
Upper endoscopy
36
PUD - radiologic testing such as Upper GI series
can detect ulcers, but cannot detect the presence of either cancer or H. pylori
37
PUD - cancer: epidemiology / diagnosis
cancer is present in 4% of thise with gastric ulcer but none o thise with Duodenal ucler The only method to diagnose gastric ca is endoscopy
38
duodenal vs gastric ulcer regarding H. pylori
Duodenal: 80-90% gastric: 50-70%
39
PPIs in PUD
responds in 95% of cases, but will ecure unless H. pylori is eradicated in those who are infected
40
H. pylori eradication (treatment)
PPIs in combination with 2 antibiotics 1. best initial: PPIs with clarythromycin and amoxicillin (or metronidazole in allergy) 2. if no respinse: metronidazole and tetracycline Adding bismuth to a change of antibiotics may aid in resolution of treatment-resistant ulcer
41
H. pylori eradication (treatment) - best initial
PPIs + clarythromycin + amoxicillin (or metronidazole in allergy)
42
H. pylori - confirmation of the eradication
1-2 months post-therapy --> retest with stool antigen or breath test
43
patient with epigastric pain from confirmed ulcer that is not responded to antibiotics - next step
if duodenal --> confirm the persistence of the active infection (Urea, stool or endoscopy) --> switch antibiotics if gastric --> repeat endoscopy to exclude cancer
44
PUD - treatment of failure most often stems from
1. nonadherence to medications 2. alcohol 3. tobacco 4. NSAID
45
differences between duodenal and gastric ulcer
- Gastric is more often worsened by food - gastric is routinely biopsed (4% cancer) - routinely repeating the endoscopy to confirm healing is standard to gastric ulcer
46
non-ulcer dyspepsia - definition
epigastric pain that has no identified etiology | with a normal endoscopy
47
non-ulcer dyspepsia - diagnosis
only by endoscopy
48
non-ulcer dyspepsia - pain is identical to
gastritis, PUD, gastric cancer, reflex
49
non-ulcer dyspepsia - management
if under 45 --> treat empirically with PPIs and scope only if do not resolve If over 55 --> endoscopy 45-55 --> unclear
50
scope dyspepsia if
1. over 55 age | 2. alarm symproms
51
alarm symptoms of dyspesia
dysphagia, weight loss, anemia
52
non ulcer dyspepsia - etiology / best initiatl therapy
unknown | best initial therapy: PPIs
53
MCC of epigastric pain
non ulcer dyspepsia
54
non ulcer dyspepsia - H. pylori
No association however, if symptoms not resolve, with initial therapy and H. pylori is present, you should try to treat it no definite benefit to treating non ulcer dyspepsia with antibiotics to eradicate H. pyori only 10% will expericne an improvement of symptoms after this
55
when to suspect gastrinoma
patients with ulcers that are | 1. large (more than 1-2cm), 2. recurrent after H. pylori eradication 3. distal in theduodenum 4. multiple
56
gastrinoma - presntation
diarrhea because acid inactivates lipase
57
gastrinoma - the most accurate test
once endoscopy confirms the presence of an ulcer, the most accurate test is by gastrin levels
58
gastrinoma - gastrin levels
1. high gastrin levels off antisecretory therapy (PPIs or H2 blockers) with high gastric acidity 2. high despite a high gastric acid output 4. persistent high gastrin levels despite injecting secretin any one of these 3 can be used to confirm the diagnosis --> the single most accurate test is always a functional test such as looking at the response of secretin
59
gastrinoma - imaging - importance
once a diagnosis of gastrinoma is confirmed, the most important issue is to exclude metastatic disease
60
gastrinoma - types
1. CT 2. MRI 3. Somatostatin receptor scintigraphy (nuclear octreotide scan combined with endoscopic US
61
gastrinoma - CT / MRI
poor sensitivity but are done first --> (-) does not exclude metastases
62
gastrinoma - Somatostatin receptor scintigraphy (nuclear octreotide scan combined with endoscopic US
do these CT and MRI are normal --> to exclude metastasis | gastrinoma is associated wit ha massive increase of somatostatin receptors in the abdomen
63
gastrinoma is aka
Zollinger- Ellison syndrome
64
gastrinoma - treatment
local disease --> removed surgically | metastatic --> udresectable --> lifelong PPI to block acid production
65
gastrinoma - MEN
MEN 1 (menin) : - pituitary tumors (prolactin or GH) - pancreatic endocrine tumors - parathyroid adenoma
66
MEN 2A
- Parathyroid huperplasia - medullary thyroid ca - pheochromocytoma
67
MEN 2B
- medullary thyroid ca - pheochromocytoma - mucosal neuromas (oral/intestinal ganglioneuromatosis) - marfanoid habitus
68
diabetic gastroparesis - definition
long standing iabetes leads to gastric dysmotility
69
the most important stimulant of GI motility
distention of the stomach and the intestines
70
Gastroparesis?
autonomic neuroapty leading to dysmotility
71
dysmotility?
from the inability to sense stretch in the GI
72
diabetic gastroparesis - look for patient with ... (symptoms)
- diabetis with chronic abdominal discomfort, bloating, and constipation - also anorexia, nausea, vomiting, early satiety
73
the most accurate test for diabetic gastroparesis
nuclear gastric emptying study (rarely needed)
74
diabetic gastroparesis - treatment
erythromycin and metoclopramide --> increase GI motility
75
diabetic gastroparesis - if it is clear diagnosis from the clinical picture
no need to do diagnostic testing, unless failure of therapy

Gastrointestinal STEP 2 (8 decks)

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