Stomach Flashcards
(13 cards)
What is prophylaxis for stress erosive/hemorrhagic gastritis
early enteral feeding (like while critically ill), H2 receptor antagonist or PPI
How do you treat erosive/hemorrhagic gastritis?
Stress → Tx: continuous PPI infusion (esomeprazole or pantoprazole) + sucralfate suspension, look for cause
NSAID → selective NSAIDs (celecoxib, etodolac, meloxicam) have less risk
Discontinue agent, reduce to lowest effective dose, take with food and PPI
Alcoholic → H2 receptor antagonists, PPIs, sucralfate
Portal HTN → propranolol or nadolol, decompressive procedures
How do you treat histologic gastritis?
H. pylori – eradication w/ antibiotics
eosinophilic – steroids
What’s treatment for gastroperesis
Correct dehydration, malnutrition, nutritional deficiencies
Dietary modification (frequent, smaller, meals)
Pharmacologic motility: prokinetics, antiemetics, pain management
Treat underlying cause
How do you treat gastric ulcers (NSAID made)
NSAID acid-antisecretory agents – PPIs (-prazole) or H2 receptor antagonists (-tidine)
Mucosal enhancers PRN to supplement antisecretory agents during first few days
How do you treat an active gastric ulcer?
Active ulcer = discontinue offending agent + start PPI therapy, test for h. Pylori
Consider risks and prevent! Oral PPI once daily when taking NSAIDs, lowest dose/time
How do you treat a duodenal ulcer?
Bismuth, tetracycline, PPI, metronidazole
need 2-3 antibiotics w/ PPI or bismuth w/ antibiotic susceptibility testing
How do you treat a duodenal PUD with an active ulcer?
Active ulcer = 14 days w/ eradication regimen followed by antisecretory agent (PPI or H2RA) for 2-4 weeks (d) or 4-6 weeks (g)
confirm eradication >4 weeks after completion w/ non invasive tests
Prevent recurrence w/ PPI
How do you treat pyloric stenosis?
Pyloromyotomy
Treat dehydration + electrolyte imbalance
Post-op vomiting is common because of gastritis, esophagitis, reflux
How do you treat metastatic zollinger-ellison syndrome?
If multiple metastases → initial therapy to control hypersecretion → oral PPI
Isolated hepatic metastases → surgical resection or cryoablation
Systemic therapy if metastatic = octreotide, tyrosine kinase inhibitors, peptide receptor radionuclide therapy
How do you treat localized zollinger-ellison syndrome?
Resect prior to hepatic spread!
Laparotomy to verify no metastasis
Surgery not recommended with MEN 1
How do you treat gastric adenocarcinoma
Surgical resection
Systemic chemo
Radiotherapy
Immunotherapy
Targeted therapy
how do you treat gastric lymphoma
MALT-Type lymphoma
H. pylori eradication, radiation
Diffuse large b-cell lymphoma
Chemo, radiation (CHOP or r-CHOP)
