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GI II: Stomach Cheat Sheet by


Peptic Ulcer Disease (PUD)

Any ulcer of the upper digestive system (gastric ulcer, duodenal ulcer)
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
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
Lab Studies
Endoscopy, urea breath test (HP)
Avoid irritating factors (NSAIDs, smoking, EtOH)
Specific Treatment for HP
PPI + clarit­hro­mycin + amoxic­illin OR Bismuth subsal­icylate plus tetrac­ycline + metron­idazole + PPI

Gastritis & Duodenitis

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
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)
Remove causative factor (NSAIDs, EtOH) + treat underlying cause

Delayed Gastric Emptying

An altera­ltion in gastric motility
Myopathic diseases of the smooth muscles and neurologic dysfun­ction
Clinical Features
Nausea + feeling of excessive fullness after a meal
Prokinetic medica­tions (cisapride metocl­opr­omide)

Neoplasm: Gastric Lymphoma

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
Resection +/- chemo/­rad­iation

Neoplasm: Zollin­ger­-El­lison Syndrome

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
PPIs (omepr­azole), or surgical resection of gastrinoma when possible

Neoplasm: Gastric Adenoc­arc­inoma

Cancer of the stomach lining (M>­>W, >40yo)
Associated with
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
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.


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