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Gastritis sx Abd pain; Indigestion; Loss of appetite; N/V; Melena
Causes of acute hemo gastritis Stress lesions, drugs, trauma (foreign body, NG tube, radiation); embolism/vasculitis; reflux injury; HP
Non-erosive chronic gastritis causes chronic superficial HP or chem gastritis; Metaplastic atrophic: autoimmune (AD, F>M 3:1, inc ca, fundus/body) or environmental (HP & diet)
Forms of gastritis Infectious (CMV, HIV, herpes, fungal, TB, syphilis); sarcoid; eosinophilic; Crohns
H Pylori dx serology; bx w/histo; bx w/urease test; urease breath test; stool antigen; PPI, Abx, or bismuth gives false neg (except serology or bx w/histo)
H Pylori eradication tx: triple tx PPI + clarithromycin + amoxicillin (+/- Flagyl).
H Pylori & ca causal: gastric adenoCa; assoc w/ MALT
ZE testing fasting gastrin level (>1000 is dx); secretin stim test (normal pt: no fx on gastrin; ZE pt: dramatic increase)
ZE tx HD PPI; resect if no mets (30-50%); mets: tx sx
ZE prognosis no mets: 15-yr 83%; mets: 10-yr 30%; fasting gastrin level prognostic
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)
PUD dx EGD & bx (4% PUD become malig); HP test
PUD complications hemorrhage (Most Common); perf; gastric outlet obstruction
PUD tx antacids, H2 blockers, PPI
Acid secretion 3 stimuli of HCl prod in parietal cell: histamine, Ach, gastrin (synergistic); somatostatin is inhibitor
PPI AE Diarrhea, nausea, abdominal pain, HA; poss C diff; hip fx risk if used LT
PUD: surg rare; gastric patch or gastrectomy w/vagotomy
High risk for NSAID complications Previous GI event; Older Age; Concomitant use of anticoagulants, corticosteroids or other NSAIDs; HD NSAID tx
NSAID complication: prevention COX-2 tx; Mucosal Protection (Misoprostol; PPI; High-dose H2 blocker)
Misoprostol Synthetic PGE1 analog; prevent NSAID-induced gastric ulcers; sig reduction (GU > DU); AE abd discomfort & diarrhea; CI in women of childbearing age
Gastric ca S/S Asx early; indigestion, nausea, early satiety, anorexia, wt loss; Late complications: Pl eff; GOO, GE obstruction, SBO, bleed; palpable stomach, hepatomegaly, pallor, Virchow & Sister Mary Joseph nodes
Gastric ca etiology Diet (pickled, salted foods, smoked meats); HP; atrophic gastritis; Polyps (rare); Radiation
Gastric ca: histo 95% adenocarcinoma; other: lymphoma, SSC
Gastric ca: imaging EGD; EUS; Barium Swallow (Upper GI); CT/MRI
Gastric ca: Tx Surgical resection (best chance for cure); Neoadjuvant CTx & XRT; Adjuvant CTx
PUD common anatomy: duodenal 5x more common than gastric; typically 5mm diameter & extend through muscularis mucosae
PUD etiologies: H pylori, NSAIDs, hypersecretory peptic states
Benign gastrin-secreting tumor usually in pancreas resulting in uninhibited secretion of gastrin & acid production = Zollinger-Ellison
What percent of pts with H pylori will need re-tx after initial eradication tx? 20%
H Pylori eradication tx: quadruple tx PPI + bismuth + Flagyl + tetracycline
Post-tx, confirm eradication of H pylori with: stool antigen
H2 blocker AEs HA, nausea, abd pain, low platelets
Created by: Abarnard