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P&T Block 3 Pulm & GI > L79 > Flashcards

Flashcards in L79 Deck (37):
1

Define dyspepsia

Stomach pain
Might also be described as indegestion
"Non-ulcer dyspepsia" = dyspepsia w/o identifiable cause after eval

2

If you feel an abdominal mass on exam, what are you thinking?

CANCER
Food in the stomach would present as distension

3

What is peptic erosin vs ulcer?

@ stomach
Due to pepsin + acid secretion
Erosion = mucosal break
Ulcer = break + DEPTH

4

What is gastritis

Inflammation of stomach

5

Causes of acute gastritis

1. NSAIDS
2. Alcohol
3. Chemo // radiation
4. Portal HTN
5. Curling or Cushing ulcer

6

What is Curling ulcer? Cushing ulcer?

Curling - ulcers that occur in BURN pts
Cushing - ulcers that occur in pts w/ severe intracranial pathology

7

5 main causes of chronic gastritis

1. H.pylori
2. AI: pernicious anemia
3. Other GI diseases: Crohn's
4. Systemic disease: GVHD, sarcoid, chronic granulomatous
5. Menetrier's disease

8

3 things gastric ulcers do

Bleed
Perforation -> penetrate adj structures
Obstruct

9

H. pylori
Transmission
What layer of stomach
Cause

Fecal-oral
Mucous layer
**Chronic gastritis -->
1. Ulcers
2. Increased risk MALToma
3. Less gastric acid -> other gastric cancers

10

4 ways to dx H.pylori

1. Ab in serum
2. Antigen in stool
3. Urea breath test (b/c bacteria makes urease)
4. Biopsy w/ UEndoscopy

11

Treat H pylori infection

2 Ab + PPI

12

How are NSAIDs linked to ulcers?

Non-selective COX 1 & 2 inhibitor
No PGs = lose GI protection

13

Describe an NSAID ulcer

Ulcer w/o inflammation
How distinguish from gastritis
@ antrum

14

If you add what drug to NSAID - this will increase risk of NSAID complications (ulcer)

Corticosteroids

15

What can you give with NSAIDs to minimize ulcer risk

Misoprostol = PGE1 analog

16

What is Zollinger Ellison syndrome?

Ectopic pancreatic tissue
Gastrinomas
= Tumors that secrete gastrin
More acid from parietal cells

17

Some ZE pts don't just have ZE alone - they have multiple endocrine neoplasia type 1. What is MEN1?

Adenomas in the:
- Parathyroid -> hyperCa
- Pancreatic islet cells -> ZE
- Pituitary gland

18

2 values to dx ZE

Acidic stomach
+
High gatrin in blood when fasting

19

Test to dx ZE

Secretin provocation
+ Secretin
See jump in serum GASTRIN

20

What are 3 reasons you'd have high serum gastrin w/o ZE?

Conditions where you lose negative FB:
- Chronic PPI/H2 blockers
- AI -> lost parietal cells
- Antral resection (no G cells)
Look for high blood gastrin w/ high pH in stomach (basic)

21

Describe how B12 gets absorbed in the diet

B12 + haptocorrin from saliva
Stomach makes IF
Pancreatic enzymes in SI cleave B12/hapto
B12 binds IF -> absorbed in distal ileum
B12 stored in the liver

22

What type of anemia will you have if B12 def?

Megaloblastic

23

What are 5 causes of B12 def?

Pernicious anemia
Gastric surgery
Pancreatic dysfxn
Ileal resection (Crohn's)
Bacterial overgrowth

24

What is pernicious anemia? Why does it result in pernicious anemia?

Abs vs IF + parietal cells
Lose both

25

Treat B12 def

B12 injections!

26

Is gastric adenocarinoma benign or malignant?

Malignant

27

Where can adenocarcinoma happen in the stomach? How does location change the likely cause?

Proximal
Distal - associated with H pylori infection

28

Treat gastric:
Adenocarcinoma
Lymphoma
MALToma

Adeno: surgery, bad prognosis
Lymphoma: chemo
MALToma - likely H pylori, try antibiotics first

29

Symptoms of gastric cancer

ASYMPTOMATIC
Why they have such bad prognosis

30

What is angiodysplasia?

= cause of occult GI bleeds

31

What causes watermelon stomach?

Dilated venules @ antrum

32

What is gatroparesis? Causes

Delayed stomach emptying
1. Peristalsis wrong
2. Diabetes

33

Dx + treat gastroparesis

Dx = gastric emptying test
Treatment not great

34

What are the 2 types of bezoar you can get?

Bezoar is stuff stuck in the stomach
Phyto = veggie
Tricho = hair

35

What are the 2 colors hematemesis can be?

Red = acute bleed
Coffee grounds = past bleed since acid has broken down the bleed

36

What are the 3 colors stool can be if it has blood in it?

Brown = occult
Black with red hue + smells BAD = melena
Red = hematochezia
Stool blood can def be from upper GI!!!

37

Why does it make sense that normally high serum gastrin should present with high stomach pH (basic)?

B/c gastrin is secreted from G cells when the pH in stomach isn't acid enough
Circulating to reach parietal cells to secrete acid to lower the pH