Gastroenterology
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Definition
Any ulcer of the upper digestive system (gastric ulcer, duodenal ulcer)
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Etiology
Any discreet break in the mucosa caused by NSAIDs, injury, stress, EtOH
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Most common cause of PUD
H. pylori (gram-negative spiral-shaped bacillus), implicated in almost all non-NSAID induced GI inflammation
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Only time that PUD can be fully treated
When caused by H. pylori
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Gastric ulcers and HP associated with
Gastric malignancy
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Ddx
Gastritis, malignancy, ischmic heart disease (can all have sx of dyspepsia, abdominal pain, discomfort, nausea)
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Clinical Features
Abdominal pain (burning/gnawing, radiates to back), Dyspepsia, Bleeding (Melena)
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Pain occurs after eating food
Gastric ulcer (-->anorexia, weight loss)
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Pain improves after eating food
Duodenal ulcer
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Most common cause of nonhemorrhagic GI bleeds
PUD
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Lab Studies
Endoscopy, urea breath test (HP)
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Treatment
Avoid irritating factors (NSAIDs, smoking, EtOH)
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Specific Treatment for HP
PPI + clarithromycin + amoxicillin OR Bismuth subsalicylate plus tetracycline + metronidazole + PPI
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Definition
Inflammation of the stomach or duodenum
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Protective factors (if imbalance, can lead to inflammation)
Mucus, bicarbonate, mucosal blood flow, prostaglandins, alkaline state, hydrophobic layer, epithelial renewal
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Causes
Autoimmune disorders (pernicious anemia), H. pylori, NSAIDSs, stress, EtOH
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Clinical Features
Dyspepsia + inflammation
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Lab Studies
Endoscopy _ bx, urea breath test to detect HP, B12 levels (pernicious anemia)
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Treatment
Remove causative factor (NSAIDs, EtOH) + treat underlying cause
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Definition
An alteraltion in gastric motility
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Etiology
Myopathic diseases of the smooth muscles and neurologic dysfunction
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Clinical Features
Nausea + feeling of excessive fullness after a meal
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Treatment
Prokinetic medications (cisapride metoclopromide)
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Definition
Lymphoma originating in the stomach, stomach most common extranodal site for non-Hodgkin's lymphoma
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Risk Factors
HP (risk of gastric lymphoma is greater by sixfold if pt. has HP infx)
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Clinical features
Dyspepsia, weight loss, anemia/bleeding, progressive dysphagia, postprandial vomiting, Virchow's node/Sister Mary Joseph nodule
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Treatment
Resection +/- chemo/radiation
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Definition
A gastrin-secreting tumor (gastrinoma from the duodenum or pancreas) causes hypergastrinemia, which results in refractory PUD
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Clinical Features
Just like PUD (abdominal pain, radiating to back), diarrhea (improves with H2 blockers), bleeding/anemia
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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
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Treatment
PPIs (omeprazole), or surgical resection of gastrinoma when possible
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Definition
Cancer of the stomach lining (M>>W, >40yo)
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Associated with
HP
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Clinical Features
Dyspepsia, weight loss, progressive dysphagia, postprandial vomiting, Virchow's node (spuraventricular lymphadenopathy), Sister Mary Joseph nodule (umbilical nodule)
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Lab Studies
Iron deficiency anemia, elevated LFTs, endoscopy in all pts >40yo + dyspepsia
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Treatment
Resection of tumor (curative/palliative), plus chemo/radiation for palliative care
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