Peptic Ulcer Disease (PUD)
|
Definition Any ulcer of the upper digestive system (gastric ulcer, duodenal ulcer)
|
|
Etiology Any discreet break in the mucosa caused by NSAIDs, injury, stress, EtOH
|
|
Most common cause of PUD H. pylori (gram-negative spiral-shaped bacillus), implicated in almost all non-NSAID induced GI inflammation
|
|
Only time that PUD can be fully treated When caused by H. pylori
|
|
Gastric ulcers and HP associated with Gastric malignancy
|
|
Ddx Gastritis, malignancy, ischmic heart disease (can all have sx of dyspepsia, abdominal pain, discomfort, nausea)
|
|
Clinical Features Abdominal pain (burning/gnawing, radiates to back), Dyspepsia, Bleeding (Melena)
|
|
Pain occurs after eating food Gastric ulcer (-->anorexia, weight loss)
|
|
Pain improves after eating food Duodenal ulcer
|
|
Most common cause of nonhemorrhagic GI bleeds PUD
|
|
Lab Studies Endoscopy, urea breath test (HP)
|
|
Treatment Avoid irritating factors (NSAIDs, smoking, EtOH)
|
|
Specific Treatment for HP PPI + clarithromycin + amoxicillin OR Bismuth subsalicylate plus tetracycline + metronidazole + PPI
|
|
|
Gastritis & Duodenitis
|
Definition Inflammation of the stomach or duodenum
|
|
Protective factors (if imbalance, can lead to inflammation) Mucus, bicarbonate, mucosal blood flow, prostaglandins, alkaline state, hydrophobic layer, epithelial renewal
|
|
Causes Autoimmune disorders (pernicious anemia), H. pylori, NSAIDSs, stress, EtOH
|
|
Clinical Features Dyspepsia + inflammation
|
|
Lab Studies Endoscopy _ bx, urea breath test to detect HP, B12 levels (pernicious anemia)
|
|
Treatment Remove causative factor (NSAIDs, EtOH) + treat underlying cause
|
Delayed Gastric Emptying
|
Definition An alteraltion in gastric motility
|
|
Etiology Myopathic diseases of the smooth muscles and neurologic dysfunction
|
|
Clinical Features Nausea + feeling of excessive fullness after a meal
|
|
Treatment Prokinetic medications (cisapride metoclopromide)
|
Neoplasm: Gastric Lymphoma
|
Definition Lymphoma originating in the stomach, stomach most common extranodal site for non-Hodgkin's lymphoma
|
|
Risk Factors HP (risk of gastric lymphoma is greater by sixfold if pt. has HP infx)
|
|
Clinical features Dyspepsia, weight loss, anemia/bleeding, progressive dysphagia, postprandial vomiting, Virchow's node/Sister Mary Joseph nodule
|
|
Treatment Resection +/- chemo/radiation
|
|
|
Neoplasm: Zollinger-Ellison Syndrome
|
Definition A gastrin-secreting tumor (gastrinoma from the duodenum or pancreas) causes hypergastrinemia, which results in refractory PUD
|
|
Clinical Features Just like PUD (abdominal pain, radiating to back), diarrhea (improves with H2 blockers), bleeding/anemia
|
|
Lab Findings Fasting gastrin level > 150 pg/mL, Secretin Test to confirm: pts given 2 U/kg secretin-->in pts with ZES the gastrin levels will increase >200 pg/mL
|
|
Treatment PPIs (omeprazole), or surgical resection of gastrinoma when possible
|
Neoplasm: Gastric Adenocarcinoma
|
Definition Cancer of the stomach lining (M>>W, >40yo)
|
|
Associated with HP
|
|
Clinical Features Dyspepsia, weight loss, progressive dysphagia, postprandial vomiting, Virchow's node (spuraventricular lymphadenopathy), Sister Mary Joseph nodule (umbilical nodule)
|
|
Lab Studies Iron deficiency anemia, elevated LFTs, endoscopy in all pts >40yo + dyspepsia
|
|
Treatment Resection of tumor (curative/palliative), plus chemo/radiation for palliative care
|
Neoplasm: Carcinoid tumors of the stomach
Can occur in response to hypergastrinemia in rare instances. Usually benign and self-limited. |
|
Created By
Metadata
Favourited By
Comments
No comments yet. Add yours below!
Add a Comment
Related Cheat Sheets
More Cheat Sheets by ksellybelly