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 & DuodenitisDefinition 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 EmptyingDefinition 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 LymphomaDefinition 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 SyndromeDefinition 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 AdenocarcinomaDefinition 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 stomachCan occur in response to hypergastrinemia in rare instances. Usually benign and self-limited. |
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