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Clin Med I- GI > Stomach > Flashcards

Stomach Flashcards

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1
Q

GERD definition

A

Reflux of gastric content into esophagus- can be acidic or basic

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2
Q

Tx of GERD

A

PPI- makes the refluxate less acidic. Reglan- decreases episodes of reflux

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3
Q

What is LES comprised of and what is function?

A

LES- comprised of the circular esophageal muscles at the base of the esophagus- held in a state of tonic contraction until person swallows, and then open to allow contents to go from esophagus to stomach

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4
Q

Pathologic reflux is defined by…

A

SYMPTOMS- more than 2-3 episodes of heartburn requiring medicine a week, and DIAGNOSTIC TESTING- DeMeester score above 14.7 on pH probe testing

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5
Q

GERD often associated with…

A

hiatal hernia

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6
Q

Most common symptom of GERD

A

heartburn

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7
Q

Regurgitation of undigested food characteristic in..

A

Zenker’s or achalasia

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8
Q

Patient presents with heartburn, epigastric, substernal pain, a burning/stinging sensation. Regurgitation of digested food. Pain does not radiate to back. Patient describes symptoms as “water brash.” Other symptoms include coughing, aspiration, and occasionally wheezing. Likely diagnosis?

A

GERD

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9
Q

Water brash

A

Excessive salivation accompanying episodes of reflux

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10
Q

3 types of hiatal hernia

A

Type I (sliding), Type II (rolling or paraesophageal), Type III (mixed)

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11
Q

HH Type I

A

Ge junction is intrathoracic

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12
Q

HH Type II

A

GE junction is intra-abdominal, but viscera can herniate into the thorax

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13
Q

HH Type III

A

GE junction and viscera are displaced

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14
Q

Questions about dysphagia to ask to patient with GERD

A

Difficulty with swallowing solid vs. liquid. Often dysphagia to solid comes first, with mechanical obstruction.

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15
Q

Patient with GERD that has dysphagia to liquids and solids equally often associated with…

A

neuromuscular disorder

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16
Q

Cause of obstruction in patients with GERD

A

peptic stricture

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17
Q

GI disorder that is a common cause of asthma in adults

A

GERD

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18
Q

Test recommended to all patients over 40 with GERD or in anyone who does not respond to therapy

A

EGD

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19
Q

Tx for hiatal hernia and GERD

A

double dose PPI for 6 weeks, follow up, check for anemia, lifestyle modification

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20
Q

If GERD patient with no response to PPI, …

A

evaluate for other causes of pain- angina, cholelithiasis, PUD

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21
Q

Major cause of duodenal and gastric ulcers

A

H. pylori

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22
Q

How does H. pylori protect itself form acidic stomach environment

A

Lives in submucosa of stomach- protection from acid and antibiotics. Also, produces urease, which cleaves urea into bicarbonate and ammonia, producing an alkaline environment for itself.

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23
Q

Non invasive vs. invasive diagnostic tests for H. pylori

A

Noninvasive- Urea breath test, fecal antigen, H. pylori serology. Invasive- rapid urease assay and H. pylori histology

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24
Q

Gold standard for determining if H. pylori present

A

H. pylori histology- tissue biopsy during EGD

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25
Effect of H. pylori
Damage to stomach- inflammation- increased gastrin levels, increased acid- ulceration or neoplasm
26
Tx for H. pylori infection
Prevpac- Prevacid, Biaxin, amoxicillin or alternate regimens- 4 agents taken Q1D
27
Common causes of gastritis
most common-NSAIDS, H. pylori, alcohol. less often- viral infection, auto immune disorder, bile reflux, cocaine, poisons
28
Chronic gastritis is a risk factor for ..
gastric cancer
29
Gastritis has strong association with...
ulcer disease
30
Patient presents with nausea, loss of appetite, upper abdominal pain, melena, coffee ground emesis, fatigue. Dx?
Gastritis
31
You suspect gastritis..what to order in workup?
CBC, EGD to examine and biopsy mucosa, H. pylori testing to see if that is the cause, hemoccult testing
32
Gastritis tx
remove offending agent, treat infection, suppress the acid
33
Tx of stress gastritis
fluid resuscitation, replacement of blood, treatment of underlying condition, NG placement, PPI
34
Prophylaxis tx in stress gastritis
Double dose IV PPI's, sucralfate 1 g q 6 hours per NG
35
Hypertrophic gastritis aka
Menetrier's disease
36
hypertrophic gastritis associated with what other disorders
CMV infection in children and H. pylori infection in adults
37
Tx in hypertrophic gastritis
anticholinergics, acid suppression, H. pylori eradication, octreotide
38
Gastric ulcer and duodenal ulcer diagnosis
UGI, EGD, CBC
39
Patient presents with upper abdominal pain, which is often RELIEVED by food. Also has nausea/anorexia. Fatigue. History of NSAID use, alcohol use, and H. Pylori infection.
Gastric ulcer
40
Peptic ulcer disease can be either...
gastric or duodenal
41
What are the 2 requirements of duodenal ulcers?
Secretion of acid and pepsin, and H. Pylori infection OR NSAID ingestion
42
Tx of gastic ulcer and duodenal ulcer
Removal of offending agent, tx of infection, acid suppression, surgery if recurrent or complicated disease
43
3 criteria of ZES
Gastric acid (HCl) hypersecretion by parietal cells, severe peptic ulcer disease, and non-beta islet cell tumor of pancreas (gastrinoma)
44
Where are gastrinomas often located
Duodenal wall, pancrease, or regional lymph nodes
45
Patient presents with steatorhea and diarrhea. Labs show increased gastrin levels and decreased secretin levels. Patient also has Multiple endocrine neoplasia. Diagnosis?
Zollinger-Ellison Syndrome
46
Why do you see steatorhea and diarrhea in ZES?
Increased HCl in ZES which causes inactivation of lipase so breakdown of fat not occuring leading to fatty stools- steatorrhea. Increased HCL also causes hyperperistalisis-->diarrhea
47
You have 2 patients with ZES. One has mass in duodenum, other does not. Tx in each case?
If mass, resect it. If no mass or metastatic disease, give ppi to reduce acid output to less than 10 mmol/hr. check acid suppression every 3 months.
48
Name benign gastric polyps. Which is most severe?
Fundic gland polyp, hyperplastic polyp, adenomatous polyp- can develop into adenocarcinoma
49
When should you remove adenomatous polyp
remove surgically when greater than 2 cm.
50
Benign gastric neoplasms
Gastric polyps and ectopic pancreas
51
95% of all MALIGNANT gastric neoplasms are...
adenocarcinomas
52
Linitis plastica
Type IV gastric adenocarcinoma- involves entire stomach
53
Boorman's classification
Type I-5 gastric adenocarcinomas. Type I- polypoid. Type II- ulcerating with elevated borders. Type 3- ulcerating with infiltration. Type 4- diffusely infiltrating
54
Virchow's node
supraclavicular lymph node, indicative of gastric adenocarcinoma
55
Sister Mary Joseph's node
Periumbilical node, indicative of gastric adenocarcinoma
56
Blumer's shelf
peritoneal metastasis in the pelvis palpable on rectal exam
57
Patient presents with weight loss, vomitting, indigestion, dysphagia. PE shows palpable abdominal mass, supraclavicular and preumbilical lymph nodes. Blumer's shelf, hepatomegaly, jaundice, ascites, cachexia. Dx?
Gastric adenocarcinoma
58
What is the problem with double contrast UGI in diagnosing gastric adenocarcinomas?
very accurate, but cannot separate benign from malignant ulcers
59
Diagnosis of gastric adenocarcinoma made by...
biopsy taken during EGD
60
gastric lymphoma tx
Chemo includes CHOP- cyclophosphamide, hydroxydaunomycin, oncovin, prednisone and radiation
61
Where does gastric sarcoma arise from?
mesenchymal cells. a GIST.
62
Dieulafoy's lesion
large tortuous vessel in the submucosa
63
In which disorder would you see Borchardt's triad?
gastric volvulus
64
Patient presents with sudden constant, severe pain, recurrent retching with little emesis, and inability to pass an NG tube. Dx?
Borchadt's triad indicating gastric volvulus
65
Patient has nausea, vomiting, upper abdominal pain, early satiety, bloating. Sx are worse with eating. There is slow gastric empyting due to denervation. What are you concerned about?
Gastroparesis
66
Diagnosis of gastroparesis
EGD, UGI, gastric emptying study
67
Tx of gastroparesis
prokinetics including Reglan and erythromycin and surgery (feeding tube)
68
Types of bezoars
phytobezoar and trichobezoar
69
Which bezoar has an underlying psychiatric disorder
trichobezoar
70
Which bezoar usually has some underlying gastric motility disorder?
phytobezoar

Clin Med I- GI (10 decks)

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