Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
33 Cards in this Set
- Front
- Back
|
What is the reading assignment for this lecture?
|
Lange Series: Current Diagnosis and Treatment: Gastroenterology, Hepatology and Endoscopy 2009: pages 175-209
|
|
|
PUD (peptic ulcer dz) is usually secondary to what two causes?
|
1. H. pylori bacteria
2. NSAIDs or ASA NSAIDs/ASA MOA for PUD isn't totally understood |
|
|
PUD affects what structures and to what depth?
|
The stomach and duodenum are affected from the surface epithelium through as deep as the muscularis mucosa.
|
|
|
*What are the cardinal signs of PUD?
|
epigastric pain described as gnawing, aching or like a "hunger pain" recurring at intervals of weeks or months that may be present or absent.
physical exam can be completely normal. do a rectal, though. do it. |
|
|
*What is the cardinal symptom of PUD in modern practice?
|
Pt will currently be taking OTC reflex meds like Prilosec (Omeprozole), Prevacid (Lansoprazole), Pepsid (Famotidine), Zantac (Ranitidine)
|
|
|
What is the Rome III criteria?
|
PUD diagnostic criteria
1. postprandial fullness 2. early satiation 3. epigastric pain or burning |
|
|
*How can you differentiate a gastric from duodenal ulcer in PUD?
|
gastric - quickly worsens with food, better with fasting, weight loss and nausea are common
duodenal - gets better for 2-4 hours after food, pain that wakes patient from sleep is common, pts gain weight because food makes pain feel better |
|
|
What PUD symptoms indicate an emergent action?
|
bleeding, melena, hematemesis, Fe deficiency anemia in male or postmenopausal female (this is PUD until proven otherwise), CA, acute worsening, pain "penetrates" to back
|
|
|
What is the differential for PUD?
|
GERD, biliary dz, hepatitis, pancreatitis, CAD, ACS, mesenteric ischemia, AAA, malignancy, electrolyte dz, systemic dz
|
|
|
What are the dx tests for H. pylori?
|
noninvasive - ELISA, urea breath test, H. pylori stool antigen
invasive - endoscopy with biopsy, histology, rapid urease test CLA, culture |
|
|
When should you not use the ELISA test for PUD H. pylori dx?
|
It's good to see if you've been exposed, but it's an antigen test. So it's useless to see if your tx is successful, as the antibody will still be there.
|
|
|
* What dx test will detect > 90% of ulcers?
|
EGD, but with 10% being missed, you should not consider it complete. Treat it, anyway.
|
|
|
What's the mortality associated with bleeding upper GI ulcers?
|
10%
|
|
|
* What significant finding could be the first manifestation of an ulcer?
|
bleeding because people self-medicate with OTC until bleeding occurs and then present
|
|
|
What is a secondary problem to PUD that can be seen on CXR?
|
perforation that can be seen as air under the diaphragm. this is not as common today as it was in the past.
|
|
|
* What associated with PUD is a proven risk factor for adenocarcinoma of the stomach?
|
H. pylori infection. these bugs actually eat on the ulcers, either causing them or making them worse. MOA not well understood.
|
|
|
* How is H. pylori PUD treated?
|
2 antibiotics and acid suppression as
1. PPI + clarithromycin or metronidazole + amoxicillin or if penicillin allergy 2. PPI + clarithromycin + metronidazole see picture for table from book. he said he will give a couple questions from this table. * How is H. pylori PUD treated? |
|
|
What is commonly not documented, but necessary for PUD tx?
|
stop NSAIDs and ASA
|
|
|
* What is Zollinger-Ellison syndrome?
|
hypersecretory gastrinomas that push out gastrin => /\ gastric acid. can be found in *pancreas and throughout the duodenum.
|
|
|
What are the serum gastrin levels with Zollinger-Ellison syndrome of the pancreas and duodenum, respectively?
|
pancreas - can approach 1000
duodenum - can present as just over normal 110 |
|
|
*What are the classic symptoms of Zollinger-Ellison?
|
PUD, abdonimal pain, diarrhea. but in practice, pts self medicate, which confuses presentation.
|
|
|
When should Zollinger-Ellison be in the differential?
|
1. self medicating GERD with OTC PPI and loose stool
2. abdominal pain without reflux after OTC 3. 4-6 weeks of OTC PPI without symptomatic resolution |
|
|
How is Zollinger-Ellison classically dx'ed?
|
1. /\ serum gastrin levels, but OTC PPI will /\ serum gastrin levels.
2. secretin test and if gastric pH <= 4 and gastrin levels are still high, then Z-E should be suspected 3. EGD 4. CT, MRI |
|
|
How is Zollinger-Ellison tx'ed with MEN 1?
|
with MEN 1, tx is controversial
without MEN 1, tx is surgical |
|
|
What is a non-ulcer (functional) dyspepsia?
|
ulcer like symptoms without evidence of an ulcer, dx of exclusion
|
|
|
How is non-ulcer dyspepsia tx'ed?
|
PPI for reflux symptoms
|
|
|
What is Eosinophilic Gastroenteritis?
|
eosinophilic infiltration of the gut wall that may affect mucosa and submucosa causing abdominal pain, nausea, vomiting, muscle layer and cause obstruction, or serosa and cause eosinophilc ascities
|
|
|
How is Eosinophilic Esophagitis tx'ed?
|
1. elimination diet to resolve mucosal dz
2. corticosteroids for muscle, serosal layer dz |
|
|
How is Eosinophilic Esophagitis dx'ed?
|
1. peripheral eosinophilia 1000 - 8000 /uL
2. upper endoscopy for mucosal dz 3. laporoscopy for muscle, serosal dz |
|
|
What is the most common malignant gastric tumor?
|
adenocarcinoma, related to H. pylori, surgery is tx
|
|
|
What are the alarm signs for gastric malignancy?
|
1. dyspepsia
2. early satiety 3. nausea/vomiting 4. weight loss 5. GI bleeding 6. iron deficiency anemia * |
|
|
* What is a MALT lymphoma?
|
H. pylori infection => chronic gastritis => gastric mucosa lymphocytic infiltrate => low grade MALT lymphoma
H. pylori tx may be curative |
|
|
What is the difference between gastric volvulus, gastroparesis, and gastric bezoar?
|
1. volvulus - presents as giant stomach on XR, and is a twisted stomach
2. gastroparesis - stomach can't empty contents, so usually appears over-distended on XR 3. bezoar - accumulation of food or foreign material in the stomach. like a hairball that gets stuck in the stomach |
