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Flashcards in Gastro - Online MedEd - misc gastric Deck (16):
1

Gastroparesis - what is it?

Gastric paralysis
Stomach fails to empty

2

Causes of gastroparesis

Idiopathic
Diabetes

3

Presentation of gastroparesis

Delayed gastric emptying: chronic N/V, abdominal pain especially with eating
-Diabetic - peripheral neuropathy, but diabetic gastroparesis is peripheral neuropathy of vagus nerve!

4

Diabetic neuropathy

Nerves to feet are longer than nerves to stomach
So in order for diabetic gastroparesis to occur --> must have damage to feet already

5

Diagnosis of gastroparesis

Rule out PUD, cancers, gastric outlet obstruction
Scope negative --> go to next step, scope cannot make definitive diagnosis of gastroparesis, but might still see food in someone who has fasted
Definitive diagnosis: emptying study

6

What is emptying study

Radiotracer with scrambled eggs
Picture at 0, 2, 4 hours
>60% at 2 hours, >10% at 4 hours = this is positive test
-Must be off opiates, off anticholinergics and have good blood glucose control

7

Treatment of gastroparesis

Avoid opiates, avoid anticholinergics, maintain good blood glucose control
-Best agent: pro kinetic agents - metachlopramide (for stable disease, PO), arithromycin (acute flare, IV), domperidone (cardiac side effects)
-Low fiber and small volume meals

8

Diabetic gastroparesis - brittle diabetics - what is there picture?

Really high sugars preprandially and really low post prandially
Challenging to control blood sugars

9

Cyclic vomiting syndrome - what is it?

Linked to THC
This is not a withdrawal/dependent thing

10

Presentation of cyclic vomiting

Habitual MJ
MJ multiple times/day
Cyclical vomiting x weeks - when get symptoms, MJ makes them feel better

11

Diagnosis of cyclic vomiting

Clinical dx
Likely do EGD and biopsy to rule out other causes
Might even get emptying study

12

Treatment of cyclic vomiting

Stop MJ
Metochlopramide
Azithryomycin
Control N/V - ondansetron

13

Gastric carcinoma - what is it?

Increased incidence in east Asia
Linked to nitrites - preservatives, diet related

14

Gastric carcinoma - presentation

Early satiety - taking up space
Unintentional weight loss
Gastric outlet obstruction
*Usually late

15

Gastric carcinoma - dx

EGD and biopsy (sigma ring cells)
PET scan/Pan scan CT for staging (90% are already spread)

16

Treatment of gastric carcinoma

Resection, chemo