Lecture 3 (GI)-Exam 1 Flashcards
(124 cards)
Peptic Ulcer Disease
* Most commony where?
* May also occur where?
- Most commonly in duodenal bulb (Duodenal Ulcer) & stomach (Gastric Ulcer)
- May also occur in esophagus, pyloric channel, duodenal loop, jejunum
CONCEPT OF GASTRIC MUCOSAL BARRIER
* What is its role?
* What is the concept of cytoprotection?
Keeps integrity of luminal mucosa despite of a pH 1.
Concept of cytoprotection:
* Several mechanisms involved; integrity of mucosa and tight junctions. Mucous layer, including bicarbonate, protective prostaglandins, blood supply.
Peptic Ulcer Disease: Etiology
* Break in that what?
* What is the most common cause of the break? When was it discovered? How is it transmitted?
Break in the mucosa
* Helicobacter pylori (most common)- Spiral Urease-producing organism
* Discovered in 1983
* Transmission is fecal oral
Peptic Ulcer Disease: Etiology
* What is the 2nd MC cause? What are 4 others causes?
- NSAIDs - #2 cause
- Stress
- Ethanol
- Injury
- Fewer than 1% are due to a gastrinoma (Zollinger-Ellison syndrome)
Peptic Ulcer Disease
* What are the complications? (5)
- Bleeding
- Perforation
- Gastric Outlet Obstruction
- Penetration causing acute pancreatitis
- Intractability
Duodenal Ulcer
* What are the clinical features?
* What is the dx?
Clinical Features
* Burning epigastric pain 90” to 3 hr after meals, often nocturnal, relieved by food or antacids
Diagnosis
* Upper endoscopy (EGD) or UGI barium radiography-> need a biospy
Dude, give me food
UGI Duodenal Ulceration
* How does it appear on imaging?
Appears as an outpouch of contrast into ulcer base & surrounded by wall of ulcer.
Penetrating Acute Duodenal Ulcer Beyond Pylorus
* What will happen over time?
* What leads to pain?
* What does it mean to perforate? What does that lead to?
- Ulcers will penetrate over time if they do not heal.
- Penetration leads to pain
- If ulcer penetrates through muscularis & through adventitia, then ulcer is said to “perforate” & leads to an acute abdomen.
Gastric Ulcer
* What are the clinical features?
* How do you dx?
Clinical Features
* Burning epigastric pain made worse by or unrelated to food
* Anorexia, food aversion, weight loss (40%)
Diagnosis
* Upper endoscopy with biopsy to exclude possibility that ulcer is malignant
Gee, I am not hungry
Endoscopic view of a Gastric Ulcer
* What does it show?
* What should all gastric ulcers undergo?
- A yellow-based ulceration with a pigmented spot is visualized on gastric wall at transition between corpus & antrum
- All Gastric Ulcers should be biopsied to RULE OUT a malignancy.
Different Tests for H. Pylori
* What are the different dx tests? (list them in terms of sensitivity)
Sensitivity goes down with each item
* Rapid urease test of antral biopsy (when endoscopy is required)
* Urea breath test
* Stool antigen testing for patients who are not taking PPIs or Bismuth and do not have acute GI bleeding
* Detection of antibodies in serum is least sensitive
Treatment Objectives in PUD
* What do you prescribe?
* Discont what?
* For Gastric Ulcers exclude what?
- RX: Proton Pump Inhibitors
- Discontinue NSAIDs!!!
- For Gastric Ulcers exclude malignancy with a biopsy via endoscopy
Treatment Objectives in PUD
* All patients with a Gastric Ulcer should have a follow-up? Can reasonably assess H.pylori resolution after what?
* Eradicate what? Markedly reduces rate of what?
All patients with a Gastric Ulcer should have a follow-up endoscopy in 6-8 weeks to confirm healing
* Can reasonably assess H.pylori resolution after CAP therapy with urea breath test
Eradication of H. Pylori (if present)
* Markedly reduces rate of ulcer relapse & indicated for all Duodenal Ulcers and Gastric Ulcers associated with H. Pylori.
H. Pylori Erradication
* What is the first line therapy?
First-line Therapy (7–10 days) – triple therapy (CAP)
* Clarithromycin 500 mg twice daily +
* Amoxicillin 1 g twice daily +
* PPI standard dose twice daily (Omeprazole)
H. Pylori Erradication
* What is the second line therapy?
Second-line Therapy (10–14 days) – quadruple therapy
* PPI standard dose twice daily +
* Metronidazole 500 mg three times daily +
* Tetracycline 500 mg 4 times daily +
* Bismuth subcitrate 120 mg 4 times daily
Gastritis: Erosive
* What is it?
* Caused by what?
* May be what or associated with what symp?
- Hemorrhagic gastritis, multiple gastric erosions
- Caused by ETOH, NSAIDs, severe stress (burns, sepsis, trauma, surgery, shock, or respiratory, renal, or liver failure)
- May be asymptomatic or associated with epigastric discomfort, nausea, hematemesis, or melena
Gastritis
* What type of dx?
* Atrophic; associated with what? (2)
* _ induced (2)
- Is a pathology diagnosis. (cannot do visual-> get biopsy)
- Atrophic; associated with H pylori, inducing an elevation of gastrin OR associated with reduction of intrinsic factor ->Pernicious anemia
- Medication induced.
- Irritant induced
Gastritis
* What is the txt?
- Treatment; avoidance of irritants.
- Eradication of H. pylori.
- Use of PPI ‘s. and H2 blockers
Gastric Cancer
* Highest incidence of what?
* Twice as common in who?
* Almost never seen in who?
- Highest incidence in Japan, China, Chile, Ireland
- Twice as common in men as in women
- Almost never seen in patients <40 y/o
Gastric Cancer
* What are the risk factors? (4)
Strong association with H Pylori
Increased incidence in lower socioeconomic groups
Dietary factors
* Nitrates
* Smoked foods
* Heavily salted foods
Genetic component suggested by increased incidence in first-degree relatives of affected
Pathology Gastric Cancer
* What is the mc type? Where does it occur?
* What are other types?
Adenocarcinoma in 85% - most common type
* 2/3 arising in antrum or lesser curvature
Other Types
* Lymphoma: Low grade tumor of mucosa-associated lymphoid tissue (MALT) or aggressive diffuse large cell lymphoma
What are the clinical features of gastric cancer? (6)
- Progressive upper abdominal discomfort
- Early satiety
- Frequently weight loss, anorexia, nausea
- Acute or chronic GI bleeding from mucosal ulceration
- Dysphagia if location in cardia
- Vomiting (pyloric involvement and widespread disease)
Red flag: I use to eat a lot but now not so much… Get EGD