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Stomach & Duodenal Diseases Flashcards

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1
Q

Diseases of the Stomach & Duodenum

A 
Gastritis
PUD
Gastric & duodenal ulcers
H. pylori
Zollinger-Ellison syndrome
Gastroparesis
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2
Q

Features of Dyspepsia

A 
Indigestion
Chronic/recurrent pain in upper abdomen
Upper abdominal fullness
Early satiety
Bloating
Belching
Nausea
Heartburn
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3
Q

Types of Gastritis

A

Erosive & hemorrhagic gastritis

Nonerosive, nonspecific gastritis

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4
Q

Types of Erosive & Hemorrhagic Gastritis

A

Stress (medical or surgical illness)
NSAID
Alcoholic
Portal hypertension

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5
Q

Types of Nonerosive & Nonspecific Gastritis

A

H. pylori
Pernicious anemia
Eosinophilic

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6
Q

Asymptomatic Gastritis May Have

A 
Anorexia
Epigastric pain
Nausea
Vomiting
Upper GI bleed
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7
Q

Upper GI Bleeding from Erosive Gastritis

A

Melena (dark, sticky feces)
Coffee ground emesis
Blood in NG tube

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8
Q

Work up of Erosive Gastritis

A

CBC
Serum iron
Upper endoscopy

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9
Q

Highest Risk for Bleeding in Stress Gastritis

A 
Coagulopathy
Need for mechanical ventilation
Trauma, burns, shock
Sepsis, liver failure, kidney disease
Multi-organ failure
CNS injury
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10
Q

Prophylaxis of Stress Gastritis

A

PPIs are best

H2 Blockers

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11
Q

Treatment for GI Bleeding due to Stress Induced Gastritis

A

PPI bolus followed by continuous infusion
Sucralfate suspension
Endoscopy

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12
Q

Red Flags for Gastritis

A 
Severe pain
Weight loss
Vomiting
GI bleeding
Anemia
Refer for Upper Endoscopy
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13
Q

Treatment of Gastritis

A

Trial of PPI for 2-4 weeks
H2 blockers
Refer for endoscopy

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14
Q

Pathophysiology of ETOH Gastritis

A

Alcohol disrupts mucosal barrier

Alcohol & aspirin increase the permeability of gastric mucosal barrier

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15
Q

Symptoms of Alcoholic Gastritis

A

Dyspepsia
Nausea
Emesis
Minor hematemesis

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16
Q

Treatment for Alcoholic Gastritis

A

H2 blockers or PPI
+ sucralfate 2-4 weeks
Decrease ETOH consumption

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17
Q

Portal Hypertensive Gastropathy

A

Congestion of gastric vessels

Chronic GI bleeding

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18
Q

Treatment of Portal Hypertensive Gastropathy

A

Porpranolol or nadolol

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19
Q

Nonerosive, nonspecific gastritis

A

H. pylori
Pernicious anemia
Eosinophilic gastritis

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20
Q

H. pylori

A 
Lives beneath gastric mucous layer
Secrete urease & produce ammonia
Causes gastric mucosal inflammation
Increases risk of gastric CA
Fecal-oral spread
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21
Q

Risk Factors for H. Pylori

A

Correlates inversely with SES

Contaminated water supply

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22
Q

What can H. pylori lead to over time?

A

Cellular changes
Duodenal/gastric ulcers
Gastric CA
Low grade B cell gastric lymphoma

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23
Q

Testing for H. pylori

A

Serology
Urea breath test
Stool antigen test
Endoscopy biopsy

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24
Q

Treatment for H. pylori

A

Eradication therapy

2-3 antibiotics + PPI or bismuth

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25
Pernicious Anemia Gastritis
Autoantibodies to gastric gland parietal cells and intrinsic factor
26
What causes loss of acid production in pernicious anemia gastritis?
Gastric gland atrophy | Mucosal atrophy
27
What can pernicious anemia gastritis be associated with?
Hashimoto thyroiditis Addison disease Graves disease
28
Define Eosinophilic Gastritis
Infiltration of eosinophils into GI tissue
29
Symptoms of Eosinophilic Gastritis
Abdominal pain N/V Early satiety Diarrhea
30
Eosinophilic Gastritis is Associated with
Hx of allergies Hx or asthma Hx of atrophy
31
Diagnosis of Eosinophilic Gastritis
Biopsy
32
Treatment of Eosinophilic Gastritis
Elimination diet | Steroids
33
Define PUD
Break in gastric or duodenal mucosa which can be caused by too much acid or pepsin >5 mm & extend through muscular mucosae
34
Where are gastric ulcers most common?
Antrum
35
Most common ages for duodenal ulcers?
30-55
36
Most common ages in gastric ulcers
55-70
37
PUD is most common in
Smokers | NSAID users
38
Etiology of PUD
NSAIDs Chronic H. pylori infection Hypersecretory states
39
What are the hypsecretory states that can cause PUD?
``` Zollinger-Ellison syndrome Systemic mastocystosis CMV Crohn's disease Lymphoma Alendronate (Fosomax) Chronic medical illness Idiopathic ```
40
Clinic Presentation of PUD
``` Dyspepsia Pain in epigastric area Pain may be relieved with food or antacids (return 2-4 hours alter) Nocturnal pain Periodicity Nausea & anorexia GI bleeding ```
41
Work Up of PUD
``` CBC FOBT/FIT Upper endoscopy Abdominal CT Biopsy ```
42
Treatment for PUD
``` PPIs H2 blockers Bismuth Misoprostol (Cytotec) Antacids ```
43
How do H2 blockers help with PUD
Inhibit nocturnal acid secretion
44
Which H2 blocker should we avoid?
Cimetidine
45
Medical Treatment of PUD
Smoking decreases ulcer healing & increases recurrence rates Moderate ETOH is okay Balanced Diet
46
Goals of Therapy for H. pylori Associated Ulcers
Relieve symptoms Promote ulcer healing Eradicate infection
47
Treatment after Triple or Quadruple Therapy for PUD
Small ulcer: no further treatment | Large/complicated ulcer: PPI fo 6 weeks
48
When should we retest for H. pylori?
>4 weeks post antibiotics | >2 weeks post PPI
49
Medical Treatment of NSAID Induced Ulcers
Stop offending agent | H2 blockers or PPIs
50
Prevention after NSAID Ulcer Healing
Long term PPI Prescribe NSAID at lowest dose Cox-2 inhibitors if no CV risks
51
Risk Factors for NSAID Uler Related Complications
``` >60 years Hx of PUD or complications ASA or other anti-platelet therapy Oral steroids Serious underlying medical illness ```
52
Zollinger-Ellison Syndrome
Gastrin secreting gut neuroendocrine tumor
53
Sites of Primary Gastrin Tumors
Pancreas 25% Duodenal wall 45% Lymph nodes 5-15% Unknown
54
Clinical Presentation of Gastrin Tumors
``` Dyspepsia Peptic ulcers in duodenum usually No isolated gastric ulcers Diarrhea Steatorrhea Weight loss ```
55
When should you check fasting gastrin levels?
``` Large ulcers > 2 cm Ulcers distal to duodenal bulb Multiple duodenal ulcers Frequently recurrent ulcers Ulcers with diarrhea Ulcers + hypercalcemia Ulcers + negative NSAID use + negate H. pylori ```
56
Imaging for Gastrin Tumors
CT/MRI to evaluate for hepatic mets & primary lesions SPECT SRS Endoscopic ultrasound
57
Treatment of Metastatic Disease in Gastrin Tumors
PPIs | Check for hepatic mets
58
Treatment for Localized Disease in Gastrin Tumors
Resection before hepatic mets occur
59
Define Gastroparesis
Delayed gastric emptying in the absence of a mechanical obstruction
60
Gastroparesis Usually Secondary to
DM Post surgical Idiopathic
61
Etiologies of Gastroparesis
Viral Medications Neurologic disease Autoimmune
62
Diabetic Gastroparesis
Chronic hyperglycemia can lead to neuropathy Autonomic dysfunction Abnormal intrinsic nervous system
63
Viral Gastroparesis
``` Norwalk Rotavirus Sudden onset Symptoms improve in a year CMV, EBV & VZV may lead to severe long term symptoms ```
64
Medications that can Delay Gastric Emptying
``` Oxycodone Clonidine TCAs CCB Dopamine agonists Muscarinic cholinergic receptor antagonists Ocreotide Phenothiazines Cyclosporine GLP-1 agonists & Amylin analongues ```
65
Examples of Muscarinic Cholinergic Receptor Antagonists that can Cause Gastroparesis
Scopolamine | Atropine
66
Ocreotide
Treat acromegaly | Diarrhea associated with certain tumors
67
Examples of Phenothiazines that can Cause Gastroparesis
Antipsychotics | Antiemetics
68
Reasons for Postsurgical Gastroparesis
``` Injury to vagus nerve Gastrectomy Fundoplication Lung/heart transplant Vatical sclerotherapy Botox injections ```
69
Neurologic Disease Causes for Gastroparesis
``` MS Brainstem stroke or tumor DM neuropathy Amyloid neuropathy AIDS DM Parkinson's ```
70
Autoimmune Gastroparesis
Idiopathic or part of a paraneoplastic syndrome
71
Other Types of Gastroparesis
Mesenteric ischemia | Scleroderma
72
Gastroparesis Symptoms
N/V Early satiety Bloating Upper abdominal pain
73
PE for Gastroparesis
Epigastric tenderness Abdominal distension Signs of underlying disorder
74
Workup of Gastroparesis
Upper endoscopy CT eneterography MRI Assessment of gastric motility
75
Scintigraphic Gastric Emptying
Nuclear med study Overnight fast Breakfast of eggs & toast with dash of isotope Imaging at interval up to 4 hours to determine degree of gastric emptying
76
Further Workup to Determine Etiology of Gastroparesis
``` Hemoglobin Fasting glucose Serum total protein Albumin TSH ANA HbA1C ```
77
Treatment of Gastroparesis
``` Dietary modifications Hydration Vitamin supplementation Optimize glycemic control Prokinetics ```
78
Dietary Modifications in Gastroparesis
Small/frequent meals Low Fat Avoid insoluble fiber, ETOH, carbonated drinks, tobacco
79
Examples of Prokinetics
Metaclopramide (Reglan) | Macrolide antibiotics
80
Metoclopramide (Reglan)
Use prior to eating | 12 week prescriptions with 2 week holiday
81
SE & Drug Interactions of Metoclopramide (Reglan) can lead to
Irreversible tardive dyskinesia
82
Erythromycin
Induces gastric contraction Stimulates fundic contractility No longer than 4 weeks at a time
83
Antiemetics
Use for persistent N/V
84
Refractory Cases of Gastroparesis
Surgical treatment G-tube J-tube

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