Term
| what artery is often a problematic bleeder in pts with gastric ulcers? |
|
Definition
| the gastric gluteal artery |
|
|
Term
| what are the mucus cells and where are they in the stomach? |
|
Definition
| the mucus cells are generally found in the upper 1/3 of the stomach and secrete mucin (a glycoprotein) to protect the gastric lining from damage |
|
|
Term
| what are the parietal cells and where are they in the stomach? |
|
Definition
| the parietal cells are found in the midportion of the stomach and produce HCl and intrinsic factor |
|
|
Term
| what are the chief cells and where are they in the stomach? |
|
Definition
| the chief cells are found in the base of the stomach and produce pepsinogen and rennin |
|
|
Term
| what other kind of secretory cells are found in the lower 2/3 of the stomach? |
|
Definition
| enterochromaffin and D cells are endocrine cells that secrete 5-HT and somatostain respectively |
|
|
Term
| at what point during embryologic development does the stomach/duodenum appear and from what original structure? |
|
Definition
| in the 4th week of gestation, the foregut gives rise to the stomach and proximal duodenum |
|
|
Term
| what are congenital abnormalities of the stomach? |
|
Definition
| atresia, mucosal membrane, diverticula, duplication of the stomach (extra stomach when rugal folds protrude out), teratomas, microgastria, and hypertrophic pyloric stenosis |
|
|
Term
| what is a common cause of early satiety/bloating/intermittent emesis of undigested food in DM pts? |
|
Definition
| gastroparesis - however the most common cause of gastroparesis over is still idiopathic |
|
|
Term
| what are some symptoms of delayed gastric emptying? |
|
Definition
| epigastric pain, nausea, vomiting, bloating, early satiety |
|
|
Term
| what is the most recognizable disorder of delayed emptying? |
|
Definition
| diabetic gastroparesis, which affects 30% of type I diabetics |
|
|
Term
| what is the best for diagnosing gastric emptying? |
|
Definition
| gastric scintigraphy - which is when you give a pt an egg w/a radioactive tracer (which binds to the albumin). when you send the pt through a scanner and 50% + of the tracer is still in the stomach after 90 min - then the pt is positive for delayed gastric emptying |
|
|
Term
| what other conditions need to be r/o before you do a gastric emptying study? why is this important? |
|
Definition
| pyloric channel block, ulcers, other anatomic blockages - very important b/c treatment for delayed emptying is prokinetic drug adminstration, which if given to a pt w/a blockage can result in death (squeezes stomach against blockage and causes perforation) |
|
|
Term
| what are the 2 most commonly used prokinetics in tx of pts with delayed gastric emptying? |
|
Definition
| metacopamide is used first, and erythromicin second if metacopamide doesn't work. (erythromycin attaches to the motilin receptors - causing contraction of the stomach). *last resort is a pacer for the stomach. |
|
|
Term
| one exam question will be on gastroparesis |
|
Definition
|
|
Term
| what is the etiology of diabetic gastroparesis? |
|
Definition
| both *phase 3 of the interdigestive migrating motor complex and *phasic activities of the postprandial antral motility are impaired in diabetic gastroparesis. |
|
|
Term
| other than diabetes, what are some other causes of gastroparesis? |
|
Definition
| post-gastric operations, progressive systemic sclerosis, or primary/secondary amyloidosis |
|
|
Term
| what can happen in severe cases of delayed gastric emptying? |
|
Definition
| neuropathic or myopathic gastric and intestinal pseudoobstruction may result (stasis) |
|
|
Term
| what are the acid peptic disorders? |
|
Definition
| gastritis, gastric ulcers, and duodenal ulcers which result from a break in the gastric mucosa |
|
|
Term
| how are the acid peptic disorders rated? |
|
Definition
| 1st level: white-based, nothing inside ulcer, less than 1% of bleeding - safe to discharge. 2nd level: flat black or red spots, benign ulcer, ~3-5% chance of bleeding - can safely discharge. the level which requires treatment involves an ulcer with a *visible blood vessel* protruding, indicating a 50% risk of bleeding w/in 48 hrs |
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|
Term
| how are gastric ulcers treated? |
|
Definition
| cauterization and local epinephrine administration w/probe - reduces risk of bleeding to ~ 15% |
|
|
Term
| there will be an exam question on kinds of ulcers, how they are treated |
|
Definition
|
|
Term
| what may appear in the stomach if pts take a lot of NSAIDs? |
|
Definition
|
|
Term
| what are the mechanisms responsible for protecting or maintaining gastric mucosal integrity? what chemical mediators regulate these mechanisms? |
|
Definition
| the mucus gel layer, membrane hydrophobicity, bicarb secretion, and mucosal blood flow - which are regulated by prostaglandins, gastrointestinal hormones, and growth factors |
|
|
Term
| what are endogenous aggressive factors which decrease the stomach's self protective mechanisms? exogenous? |
|
Definition
| endogenous: hyperacid secretion and excess pepsin. exogenous: H. pylori, anti-inflammatory drugs |
|
|
Term
| can gastric ulcers contribute to blockage in the stomach? |
|
Definition
| yes - esp if near the pylorus, inflammation/edema may extrude enough to block movement of material through that section of the GI |
|
|
Term
| what kind of ulcer may be caused by feeding tube placement in the stomach? |
|
Definition
| a pressure ulcer, which may be hidden by the causative tube |
|
|
Term
| what diseases are commonly caused by H. pylori? |
|
Definition
| chronic gastritis, most peptic ulcers, and gastric adenocarcinoma/lymphoma |
|
|
Term
| there will be question on H. pylori on the exam |
|
Definition
|
|
Term
| what kind of bacteria is H. pylori? |
|
Definition
| spiral shaped, gram negative, flagellated bacteria |
|
|
Term
| what is the most common chronic bacterial infection in humans? |
|
Definition
|
|
Term
| how does H. pylori cause disease in the GI? |
|
Definition
| H. pylori on the surface of the stomach cause inflammation, released ammonia and urease, release toxins, stimulate G cells w/inflammatory response and stimulate parietal cells into HCl oversecretion |
|
|
Term
| what is the route of transmission for H. pylori? |
|
Definition
| unknown...thought to be person to person, fecal-oral or oral-oral |
|
|
Term
| what are the reservoirs for H. pylori? |
|
Definition
| humans (major), also in primates, cats and sheep |
|
|
Term
| what is the reinfection rate of H. pylori after initial successful tx? |
|
Definition
|
|
Term
| what part of the population has a higher incidence of H. pylori infection? |
|
Definition
|
|
Term
| what are the invasive techniques for diagnosing an H. pylori infection? |
|
Definition
| bx, then urease test/histology/bacterial cx |
|
|
Term
| what are the non-invasive techniques for diagnosing an H. pylori infection? |
|
Definition
| urea breath test (UBT), stool antigen (very specific), serology (though don't know if ab detected is current), and polymerase chain reaction (PCR) |
|
|
Term
| what is the difference between sensitivity and specificity? |
|
Definition
sensitivity = probability of a positive test among patients with disease
specificity = probability of a negative test among patients without disease |
|
|
Term
| when should H. pylori be tested for? what is a general rule for testing/tx? |
|
Definition
| when a pt has an active peptic ulcer, past hx of an ulcer or a gastric MALT lymphoma. *testing should only be performed if tx is intended.* |
|
|
Term
| what % of duodenal ulcer pts have a detectable H. pylori infection? (*question will be on exam*) |
|
Definition
|
|
Term
| what % of gastric ulcer pts have a detectable H. pylori infection? (*question will be on exam*) |
|
Definition
|
|
Term
| what % of dyspepsia pts have a detectable H. pylori infection? (*question will be on exam*) |
|
Definition
|
|
Term
| what % of gastric CA pts have a detectable H. pylori infection? (*question will be on exam*) |
|
Definition
|
|
Term
| what % of asymptomatic pts have an H. pylori infection? should these pts be treated? |
|
Definition
| 20-45% - no, not unless they have symptoms or a hx of ulcers/gastric CA |
|
|
Term
| what % of pts infected with H. pylori develop an ulcer? |
|
Definition
|
|
Term
| do NSAID users infected with H. pylori have a higher incidence of PUD? |
|
Definition
| yes - this is important in deciding to treat asymptomatic (in terms of GI) pt with H. pylori for things like arthritis |
|
|
Term
| does eradication of H. pylori reduce risk of ulcer recurrence? |
|
Definition
|
|
Term
| what is the treatment regimen for H. pylori infections? |
|
Definition
| 2 antibx + PPI 2x/day for 1-2 wks. clarithromycin, amoxicillin, nexium, and prilosec are all good options. |
|
|
Term
| what is zollinger-ellison syndrome? |
|
Definition
| a condition involving ulceration of the upper jejunum, hypersecretion of gastric acid, and non-beta islet cell tumors of the pancreas - mediated by the overproduction of gastrin *due to a gastrinoma. this should be in the ddx for any pt with PUD. |
|
|
Term
| is the incidence of zollinger-ellison syndrome linked to anything? |
|
Definition
| ZE can be sporadic, though there is some association with MEN1 syndrome (3 P's: parathyroid tumor, anterior pituitary tumor, and pancreatic tumors) |
|
|
Term
| where are most gastrinomas found? |
|
Definition
| 70% are found in the duodenum |
|
|
Term
| do most pt w/a gastrinoma develop PUD? |
|
Definition
|
|
Term
| what are clinical presentations of a pt with a gastrinoma? |
|
Definition
|
|
Term
| can gastrinomas metastasize? |
|
Definition
| yes, they can be malignant and met to *liver and bone* |
|
|
Term
| how does a gastrinoma affect the gastric folds? |
|
Definition
| pts with gastrinomas have prominent gastric folds which can be seen on endoscopy - due to mucus, parietal, G cell hypertrophy |
|
|
Term
| if a pt has PUD, but doesn't improve with antibx and a NSAID useage decrease, what needs to be considered? |
|
Definition
|
|
Term
| there will be a test question on gastrinomas |
|
Definition
|
|
Term
| what is the main way to test for a gastrinoma? |
|
Definition
| check fasting serum gastrin level, if over 1,000, then this is diagnostic for a gastrinoma |
|
|
Term
| what are other ways of testing for a gastrinoma? |
|
Definition
| secretin stimulation test, gastrin secretion studies, and chromogranin A (general marker for neuroendocrine tumors, which is elevated in most pts w/gastrinoma) |
|
|
Term
| what is the next step after confirming the presence of a gastrinoma? |
|
Definition
| location and staging. somatostatin receptor imaging will locate it most of the time, though if it doesn't, an endoscopic ultrasound may be used |
|
|
Term
| what are other, less common ways of locating a gastrinoma? |
|
Definition
| 64 slice CT scan (HD), MRI, angiography, laparotomy |
|
|
Term
| where are most gastrinomas located? |
|
Definition
| in the gastrinoma triangle, between the head of the pancreas and duodenum |
|
|
Term
| what is tx for a gastrinoma? |
|
Definition
| acid suppression (usually high dose PPI) and sx (only for sporadic gastrinoma not associated with MEN1 syndrome and/or not associated with mets) |
|
|
Term
| what is the prognosis for gastrinoma pts with metastasis? |
|
Definition
| liver mets: 10 yr survival - 30%. no liver mets: 15 yr survival - 83% |
|
|
Term
| barium studies look for 1 of 2 things, what are they? how does this relate to diagnosing gastritis? |
|
Definition
| barium uptake or barium displacement. masses in the stomach will displace barium and ulcers will take up barium. |
|
|
Term
| with an upper GI bleed, what are the most important parts of blood work to address first? |
|
Definition
| H/H: hemoglobin/hematocrit, if the pt is bleeding - they may need a transfusion. platelets: if low, need more platelets. PT/PTT: if pt on coumadin, blood thinner, or is an alcoholic w/cirrhosis - may need to give clotting factors/vit K/fresh frozen plasma |
|
|
Term
| for a pt with hematemesis, a hx of heavy NSAID use, and blood work has been checked and addressed, what is the next test to be done? |
|
Definition
| an upper endoscopy - to look for an ulcer (*likely test question*) |
|
|
Term
| when should an upper GI series never be ordered? |
|
Definition
|
|
Term
| what is the test of choice for a lower GI bleed? |
|
Definition
|
|
Term
|
Definition
| a bleed in the stomach surrounded by NO ulceration |
|
|
Term
| what is gastritis? how does it appear? what usually will cause it? |
|
Definition
| inflammation of the stomach due to epithelial damage/repair. it appears red, boggy, and edematous and is usually due to infection/drugs/autoimmune/hypersensitivity reactions |
|
|
Term
|
Definition
| epithelial damage/repair *without inflammation* (no PMNs on bx). gastropathy is usually due to drugs/bile reflux/stress/hypovolemia/chronic vascular congestion |
|
|
Term
| what is menetrier disease? |
|
Definition
| large/thick rugal folds along with hyertrophied mucus cells |
|
|
Term
| what is gastric antral vascular ectasia (GAVE)? what can it commonly cause? |
|
Definition
| also called watermelon stomach (due to radiating red folds), GAVE is a form of gastropathy b/c no inflammatory cells are present. it is a common cause of iron deficiency anemia |
|
|
Term
| what is the most common internal CA internationally? |
|
Definition
| gastric CA, which is extremely common in japan - less so in the US |
|
|
Term
| gastric CA: more common in M or F? |
|
Definition
|
|
Term
| what are the different types of early (does not invade mucosa) gastric CA? what is the prognosis for early gastric CA? |
|
Definition
| polypoid, elevated but flat, flat, depressed, and excavated. early gastric CA prognosis much better than for advanced. |
|
|
Term
| what are the different types of advanced (mucosa is invaded) gastric CA? |
|
Definition
| polypoid, ulcerating, and linitis plastica (whole wall of stomach is involved, looks leathery - can't distend/contract, high mortality) |
|
|
Term
| how long should you follow a gastric ulcer? duodenal? |
|
Definition
| gastric: until it has completely healed (bx for each endoscopy), duodenal: doesn't have to be followed as closely, they are rarely malignant |
|
|
Term
| what gastric CA is associated with H. pylori? |
|
Definition
|
|
Term
| what is the most common benign tumor of the stomach? how does it appear on endoscopic ultrasound (EUS)? |
|
Definition
| leiomyoma - which rises from the smooth muscle within the wall of the stomach, from the muscularis propria. on endoscopic ultrasound (EUS), leiomyomas appear hypoechoic and non-ulcerated |
|
|
Term
| what is a leiomyosarcoma? |
|
Definition
| the malignant counterpart to the leiomyoma - will be ulcerated |
|
|
Term
|
Definition
| persistent concentrations of foreign matter - most commonly plant/vegetable fibers (phytobezoars), persimmons (disopyrobezoars), and hair (trichobezoars) which are stuck in the stomach b/c they can't exit the pylorus. they are diagnosed by UGI series/endoscopy |
|
|
Term
| what is trichophagia? trichotillomania? |
|
Definition
| hair eating and hair pulling |
|
|
Term
| how will a bezoar appear on an x-ray? UGI series? |
|
Definition
| mottled on x-ray, trickling on UGI |
|
|
Term
| who are most GI foreign bodies seen in? |
|
Definition
| children, adults w/psychosis or dementia |
|
|
Term
| what foreign bodies need to be removed? |
|
Definition
| sharp objects or objects greater than 2 cm in width and 5 cm in length |
|
|
Term
| what is the most common place in the GI for foreign bodies to get stuck? |
|
Definition
| ileocecal valve (requires sx) |
|
|
Term
| what is gastric volvulus? |
|
Definition
| abnormal degree of rotation of one part of the stomach around another |
|
|
Term
| what are the 2 types of gastric volvulus? |
|
Definition
| organoaxial: stomach flips over on itself so posterior part becomes anterior part and the greater curve goes up to there the lesser curve should be (more common). mesoenteraxial: pylorus flips up more anteriorly |
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