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GI II: Stomach Cheat Sheet by

Gastroenterology
medical     disease     gastroenterology     stomach     neoplasm     pud

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.

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