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Clinical Medicine III > GI: PUD & Gastric CA > Flashcards

GI: PUD & Gastric CA Flashcards

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1
Q

these cells secrete HCl and IF

A

parietal

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2
Q

These cells secrete pepsinogen

A

Chief

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3
Q

These cells of the GI system secrete hormones

A

enteroendocrine

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4
Q

This disease is characterized by extension of an ulcer through which layers

A

Peptic ulcer disease

ulcer thru muscularis mucosa

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5
Q

5 Risk factors for PUD?

A

smoking/EtOH/Diet
Genes
Psych/stress

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6
Q

Smoking confers increased risk for what complication of PUD?

A

perf

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7
Q

EtOH confers increased risk for what PUD complication?

A

bleed

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8
Q

What blood types are at increased risk for PUD?

A

O and A

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9
Q

Stress and psych issues increase risk of PUD via…

A

impaired tissue healing

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10
Q

2 main mechanisms that cause PUD?

A

NSAIDs and H. Pylori

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11
Q

What is the MC cause of PUD and confers increased risk of gastric CA?

A

H. Pylori

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12
Q

H. pylori is G- motile flagellated bacteria that has what four virulence factors?

A

flagella
urease
adhesins
inflammation

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13
Q

NSAIDs decrease production of ______ which confers in creased risk of PUD

A

prostaglandins

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14
Q

The below indicate what drug class should be avoided when possible due to increased PUD risk?

  1. Prior PUD hx
  2. H. pylori
  3. > 75 yo
  4. Increased dose, time, duration
  5. Use w. steroids, anticoags, ASA, SSRI, alendronate
A

NSAIDs

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15
Q

What four drugs shouldn’t be combined w. NSAIDs due to increased PUD risk?

A

steroids, anticoags, SSRI, alendronate

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16
Q

Most cases of PUD are asymptomatic… but what sxs would be most common?

A

UGI discomfort + Dyspepsia

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17
Q

Belching, bloating, distension, N/V and early satiety are signs of…

A

dyspepsia

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18
Q

What are three signs/sxs of PUD complication?

A

Bleed (hematemesis/melena)
fatigue
dyspnea

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19
Q

The below sxs should warrant…

i. Bleeding
ii. IDA
iii. early satiety
iv. Weight loss
v. Progressive dysphagia/odynophagia
vi. Acute and intense upper abd. Pain
vii. Persistent vomiting
viii. FHx of UGI CA (ask in ROS)

A

prompt PUD eval

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20
Q

Where is the ulcer located?

worse after meal
(+) vomiting
(+) hematemesis, WL/Anorexia

A

Gastric ulcer

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21
Q

Where is the ulcer located?

relieved after meal
(-) vomiting
weight gain
+/- melena/bleeding

A

Duodenal ulcer

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22
Q

4 major complications of PUD?

A

Bleeding
Perf
Penetration
Gastric Outlet Obstruction

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23
Q

A patient w. PUD p/w… this is concerning for…

Hematemesis
Melena
Hematochezia

A

bleeding

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24
Q

How is bleeding treated with PUD patients?

A

IV Fluids/PRBCs (stabilize)

IV PPI
+
EGD w.:
Thermal coag/hemoclip/injection

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25
A patient w. PUD p/w... this is concerning for... ``` Severe/Diffuse Abd. Pain Tachy Weak Pulse N/V Abd. Rigidity ```
Perforation
26
How is perforation diagnosed w. PUD patients?
upright CXR + Abd. XR (showing pneumoperitoneum) +/- CT ( to localize)
27
How is perforation treated w. PUD patients?
IV Fluids + NG suction + IV PPI + broad spec abx THEN Surgery
28
PUD penetration is a leakage of luminal contents to peritoneum, it is most commonly effecting which organ?
pancreas
29
A pt. w/ PUD p/w intense pain that refers to the back. This is concerning for...
Penetration
30
A pt. w/ PUD p/w the below, which is concerning for... ``` Vomiting early satiety bloating epigastric pain weight loss anorexia ```
Gastric Outlet Obstruction
31
Scarring/Fibrosis or Inflammation/edema in pyloric channel can cause...
gastric outlet obstruction
32
How is gastric outlet obstruction diagnosed
XR showing dilated stomach and + succession splash
33
How is gastric outlet obstruction treated?
IV Fluids (stabilize) NG Tube + Gastric Decompression IV PPI
34
If medical therapy for gastric outlet obstruction fails, what intervention is indicated?
EGD + endoscopic balloon dilation OR Surg.
35
On physical exam, a pt. p/w ``` hypotension tachycardia epigastric/RUQ tenderness (+) peritoneal signs (+) succession splash (+) hemoccult ``` This is concerning for...
PUD
36
What two imaging modalities are indicated for PUD diagnosis, which is more sensitive/specific for h. pylori?
EGD + Bx UGI Barium Study
37
The best diagnostic for H. pylori is...
EGD + Bx
38
This H. pylori test... determines active or eradicated h. pylori measures for radiolabeled CO2 during exhalation after drinking radiolabeled urea
Urea Breath Test
39
What meds must be discontinued before urea breath tests?
PPI (1-2 weeks prior) | Abx/Bismuth (4 weeks prior)
40
T/F: Stool antigen tests require the same meds to be discontinued
T
41
IS serology recommended for h. pylori testing? why or why not?
no, high rate of false + and -
42
Tx for PUD w. H. pylori infx
Clarithromycin + PPI + Ammoxicillin x 14 days OR Bismuth + PPI + metronidazole + tetracycline x 14 days
43
Tx for PUD if NEG h. pylori
assume NSAID induced discontinue NSAID + PPI x 6-8 weeks
44
Tx for PUD if NEG NSAID induced and NEG h. pylori
PPI x 4-8 weeks + EGD repeat EGD after PPI
45
ZES is caused by ______ in the
gastrinoma in duodenum or pancreas
46
Gastrinoma releases gastrin, which has what to effects?
increased HCl and Gastric motility
47
80% of ZES gastrinomas are spontaneous, 20% are part of what type of tumor?
MEN1
48
A pt. presents w. the below, which is concerning for... Recurrent PUD distal to duodenal bulb upper abd. pain steatorrhea/diarrhea
ZES
49
How is ZES diagnosed?
serum gastrin > 1000 pH < 2 Secretin stim.: gastrin increase 200
50
What is CT used for in ZES?
tumor localization
51
What is the tx for ZES?
PPI + resection
52
MC type of gastric CA...
adenocarcinoma
53
4 RFs for gastric CA?
percursor lesions (MC) diet (smoked foods, salt) lifestyle (TOBB/EtOH) H. Pylori
54
A patient presents w. ``` Wt. loss Persistant abd. pain Hx. gastric ulcer GI bleed early satiety dysphagia NV (+) FHx CA ```
Gastric CA
55
What are three late stage signs/sxs of gastric CA?
palpable mass succession splash paraneoplastic syndromes
56
1st line diagnostic for gastric CA?
EGD + Bx and histo
57
the below histologic findings are indicative of... i. Subtle polypoid protrusion ii. Superficial plaque iii. Mucosal discoloration iv. Depression v. ulcer
Gastric CA
58
What is the 2nd line Dx for Gastric CA?
UGI study
59
Describe the staging for Gastric CA?
TNM (Submucosal to superficial m. to deep m. to serosa)
60
A palpable left supraclavicular node is found. this is called a ___ node and is a sign of...
Virchow's Node MC sign of mets from gastric CA
61
periumbilical node found in Gastric CA mets is called...
sister mary joseph's node
62
left axillary node found in Gastric CA mets is called...
Irish node
63
If, however rare, gastric CA is discovered early, what is the Tx?
endoscopic mucosal resection
64
Advanced gastric CA is tx by...
total or partial gastrectomy
65
Unresectable gastric CA is treated palliatively with either...
Chemo or Radiation
66
Abd. discomfort +/- bloating, belching, distension...
dyspepsia
67
Pt. who is 60+ with dyspepsia should have what workup?
EGD + bx Tx if PUD present
68
If no organic dz is found to cause dyspepsia, it is considered functional dyspepsia. This requires...
H. pylori testing and Tx
69
Pt. who is < 60 with dyspepsia should have EGD only if one of what 4 things?
wt. loss bleeding 2+ alarm features rapid progression of alarm fts

Clinical Medicine III (21 decks)

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