Gastroenterology
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| Abd pain, indigestion, loss of appetite, N&V, and melena can be symptoms of: | Gastritis
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| Causes of acute hemolytic gastritis (6) | Stress lesions, drugs, trauma (foreign body, NG tube, radiation); embolism/vasculitis; reflux injury; H Pylori
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| Causes of non-erosive chronic gastritis | chronic superficial H Pylori or chemical gastritis; metaplastic atrophic: autoimmune (AD, F>M 3:1, fundus/body) or environmental (H Pylori & diet)
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| Forms of gastritis (4) | Infectious (CMV, HIV, herpes, fungal, TB, syphilis); sarcoid; eosinophilic; Crohns
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| H Pylori diagnostic tests (5) | Serology. Bx w/histology. Bx w/urease test. Urea breath test. Stool antigen
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| H Pylori & ca | causal: gastric adenoCa; assoc w/ MALT
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| ZE testing | fasting gastrin level (>1000 is dx); secretin stim test (normal pt: no fx on gastrin; ZE pt: dramatic increase)
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| ZE tx | HD PPI; resect if no mets (30-50%); mets: tx sx
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| ZE prognosis | no mets: 15-yr 83%; mets: 10-yr 30%; fasting gastrin level prognostic
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| PUD sx | Burning pain localized to the epigastrum, non-radiating; gastric ulcer: worse with meals; duod ulcer: better with meals, more often pain at night (wakes pt 2-3 AM)(DU>GU)
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| PUD dx | EGD & bx (4% PUD become malig); HP test
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| PUD complications | hemorrhage (Most Common); perf; gastric outlet obstruction
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| PUD tx | antacids, H2 blockers, PPI
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| Acid secretion | 3 stimuli of HCl prod in parietal cell: histamine, Ach, gastrin (synergistic); somatostatin is inhibitor
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| PPI AE | Diarrhea, nausea, abdominal pain, HA; poss C diff; hip fx risk if used LT
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| PUD: surg | rare; gastric patch or gastrectomy w/vagotomy
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| High risk for NSAID complications | Previous GI event; Older Age; Concomitant use of anticoagulants, corticosteroids or other NSAIDs; HD NSAID tx
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| NSAID complication: prevention (2) | COX-2 tx; Mucosal Protection (Misoprostol; PPI; High-dose H2 blocker)
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| What is misoprostol and what is its use in tx of ulcers? | Synthetic PGE1 analog; prevent NSAID-induced gastric ulcers; sig reduction (GU > DU); AE abd discomfort & diarrhea; CI in women of childbearing age
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| Gastric cancer: early sxs | Asymptomatic early (later: indigestion, nausea, early satiety, anorexia, wt loss)
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| Gastric ca etiology (5) | Diet (pickled, salted foods, smoked meats); H pylori; atrophic gastritis; Polyps (rare); Radiation
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| Gastric ca: histology | 95% adenocarcinoma; other: lymphoma, SSC
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| Gastric ca: imaging (4) | EGD; EUS; Barium Swallow (Upper GI); CT/MRI
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| Gastric ca: Tx (3) | Surgical resection (best chance for cure); Neoadjuvant chemo & XRT; Adjuvant chemo
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| PUD common anatomy: | duodenal 5x more common than gastric; typically 5 mm diameter & extend through muscularis mucosae
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| PUD etiologies: | H pylori, NSAIDs, hypersecretory peptic states
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| Benign gastrin-secreting tumor usually in pancreas resulting in uninhibited secretion of gastrin & acid production = | Zollinger-Ellison
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| What percent of pts with H pylori will need re-tx after initial eradication tx? | 20%
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| H Pylori eradication tx: quadruple tx | PPI + bismuth + metronidazole + tetracycline
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| Post-tx, confirm eradication of H pylori with: | stool antigen
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| H2 blocker AEs | HA, nausea, abd pain, low platelets
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| rapid urease test sensitivity & specificity: | sensitivity 90%; specificity 98%
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| If rapid urease test is negative, do: | Histo stain
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| H pylori test that stays positive | Serology
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| H pylori test used as test of cure | Fecal Ag
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| Meds that can cause false-negative H pylori tests | PPI (avoid x14 days prior to breath test), Abx, or bismuth gives false neg (except in serology or bx w/histo)
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| Common causes of gastritis | NSAIDs, EtOH, stress, portal HTN
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| Tx for PUD/H pylori eradication | Triple therapy: (PPI or H2 blocker) + clarithromycin + (amoxicillin +/- metronidazole) x 7-14 days
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| Multiple or constant GI ulcer pain despite medications may be due to: | Zollinger-Ellison Syndrome
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| Burning, non-radiating epigastric pain; may be sx of: | Peptic ulcer disease
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| H pylori infection (in body/fundus) resulting in acid hyposecretion can lead to: | atrophic gastritis => intestinal metaplasia => gastric cancer
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| H pylori infection (in antrum) resulting in acid hypersecretion can lead to: | duodenal gastric metaplasia => inflammation => ulceration
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| Tissue injury associated with H pylori is due to production of lipopolysaccharides, leukocyte-activating factors, and (2): | CagA and VacA proteins
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| gastric ulcer: effect of eating on symptoms with meals | Pain is worse
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| Duodenal ulcer: effect of eating | Pain is better. More often pain at night (wakes pt 2-3 AM)(DU>GU)
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| Late complications in gastric cancer (5) | Pleural effusion; gastric outlet/GE obstruction, SBO, bleed; palpable stomach; hepatomegaly; Virchow & Sister Mary Joseph nodes
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| In autoimmune atrophic gastritis, loss of parietal cells results in (3): |
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