Disorders of the Stomach Flashcards Preview

Clin Med GI > Disorders of the Stomach > Flashcards

Flashcards in Disorders of the Stomach Deck (23)
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1
Q

There are just TWO major causes of peptic ulcer disease - what are they?

A

H. pylori: more duodenal ulcers

NSAIDs: more gastric ulcers

2
Q

What symptom is the hallmark of PUD?

A

epigastric pain that is gnawing, dull, aching, or hunger-like

3
Q

What is the procedure of choice for diagnosing duodenal and gastric ulcers?

A

upper endoscopy

4
Q

You should biopsy both duodenal and gastric ulcers.

T/F

A

False
Duodenal ulcers are virtually never malignant and do not require biopsy.
3-5% of benign-appearing gastric ulcers prove to be malignant and therefore ulcer margin biopsies are almost always done.

5
Q

What could it mean if a patient’s typical rhythmic discomfort (from ulcers) changes to constant or radiating pain?

A

May reflect ulcer penetration or perforation

6
Q

What are two acid-antisecretory agents used to treat ulcers?

A
  1. PPIs

2. H2-receptor antagonists

7
Q

What time of day should patients take PPIs and H2-receptor blockers?

A

PPIs: 30 minutes prior to breakfast; make sure to eat

H2-receptor blockers: once daily at bedtime

8
Q

What is the standard triple therapy for H. pylori?

A
  1. PPI
  2. clarithromycin
  3. amoxicillin
9
Q

What is the standard quadruple therapy for H. pylori?

A
  1. PPI
  2. bismuth subsalicylate
  3. tetracycline
  4. metronidazole
10
Q

Patients with ulcers should eat only bland foods, avoid alcohol, and quit smoking.
T/F

A

False, false, true
~There is no justification for bland or restrictive diets
~Moderate alcohol intake is not harmful
~Smoking retards healing and increases recurrences!

11
Q

Erosive gastritis and hemorrhagic gastritis most commonly caused by what?

A
  • drugs (NSAIDs)
  • alcohol
  • stress (from major medical or surgical illness)
  • portal HTN
12
Q

S/s of erosive/hemorrhagic gastritis?

A
  • often asymptomatic
  • dyspepsia, anorexia, epigastric pain, nausea/vomiting
  • hematemesis or coffee ground emesis (bleeding not usually significant)
13
Q

Patients with pernicious anemia gastritis are at increased risk for what?

A

gastric adenocarcinoma (3x increased risk)

14
Q

What are the main types of nonerosive, non specific gastritis?

A
  • H. pylori
  • pernicious anemia
  • eosinophilic gastritis
15
Q

What is the most common cause of dyspepsia?

A

functional dyspepsia - no organic cause

16
Q

What diagnostic workup is done for dyspepsia?

A

If < 55 with uncomplicated dyspepsia: test for H. pylori or do PPI trial
If > 55 or with “alarm” symptoms (wt loss, dysphagia, recurrent vomiting, bleeding): CBC, electrolytes, liver enzymes, calcium, thyroid function, PLUS upper endoscopy

17
Q

60-90% of gastric cancers are attributable to what?

A

H. pylori

18
Q

What are four environmental risk factors for gastric cancer?

A
  1. high nitrate diet
  2. low vitamin C
  3. hx pernicious anemia
  4. hx gastric resection
19
Q

What two medications may be taken before meals by a patient with diabetic gastroparesis?

A

metoclopramide and erythromycin

both stimulate stomach contractions

20
Q

T/F: peptic ulcers are 5x more common in duodenum than in the stomach

A

TRUTH!

21
Q

Less than 1% of peptic ulcer disease is caused by what?

A

Zollinger-Ellison syndrome (gastrinoma)

22
Q

T/F over 2/3 of gastrinomas are malignant

A

TRUE!

in fact: over 1/3 have already metastasized to the LIVER at initial presentation

23
Q

what is a common s/s for gastrinoma?

A
  • diarrhea
  • ->fun fact: nasogastric suction of stomach acid stops the diarrhea
  • gastric acid hypersecretion (leads to peptic ulcers)