Term
| What are the 2 main categories of gastritis? |
|
Definition
| 1)Erosive and hemorrhagic 2)Nonerosive, nonspecific |
|
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Term
| What is the most common presenting sign of erosive/hemorrhagic gastritis? |
|
Definition
| Upper GI bleeding (coffee ground emesis and/or melena) |
|
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Term
| What are typical presenting c/o in pts w/ erosive/hemorrhagic esophagitis? |
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Definition
| Usually asymptomatic but may c/o anorexia, epigastric pain, N/V |
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Term
| What are the most common causes of erosive/hemorrhagic esophagitis? |
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Definition
| Drugs (NSAIDs), etoh, and stress d/t severe illness |
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Term
| Endoscopy can be used to dx erosive or non-erosive gastritis? |
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Definition
| Erosive (usually normal in non-erosive) |
|
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Term
| What lab values may be altered in a pt w/ erosive gastritis? |
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Definition
| Low hematocrit (anemia) if severe bleeding |
|
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Term
| How is erosive esophagitis treated? |
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Definition
| Stop offending agent and start acid suppresive tx |
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|
Term
| What is the main cause of non-erosive gastritis? |
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Definition
|
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Term
| What tests can be used to dx H pylori gastritis? |
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Definition
| Positive urease production test and endoscopic bx revealing inflammation |
|
|
Term
| What is the tx for H pylori gastritis? |
|
Definition
| 2 abx and a proton pump inhibitor |
|
|
Term
|
Definition
| 1)Incompetent LES 2)Hiatal hernia 3)Elevated acid in stomach 4)Delayed gastric emptying |
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|
Term
| What is the hallmark sign of GERD? |
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Definition
| Heartburn occuring 30-60 min /p a meal and/or upon reclining |
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Term
| What sx occurs in 1/3 of pts w/ GERD? |
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Definition
|
|
Term
| What is the spontaneous reflux of sour or bitter gastric contents into the mouth in pts w/ GERD? |
|
Definition
|
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Term
| Name 5 atypical findings in pts w/ GERD. |
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Definition
| 1)Asthma sx 2)Chronic cough 3)Chronic laryngitis 4)Sore throat 5)Noncardiac CP |
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|
Term
| What is the standard diagnostic test for GERD? |
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Definition
|
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Term
| What diagnostic test can be done for severe dysphgia in GERD to identify a stricture? |
|
Definition
|
|
Term
| What diagnostic test is done in atypical cases of GERD? |
|
Definition
|
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Term
| Barrett's esophagus, a complication of GERD, occurs when the squamous epithelium of the esophagus is replaced by ___________. |
|
Definition
| Metaplastic columnar epithelium |
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Term
| Barrett esophagus is suspected in endoscopy from the presence of __________. |
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Definition
| Orange, gastric type epithelium extending upward from the stomach |
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Term
| What is the most serious complication of Barrett esophagus? What is the yearly incidence of pt's w/ this complication? |
|
Definition
| Esophageal adenocarcinoma. 0.5% |
|
|
Term
| what % of pt's w/ GERD dev. Barrett's esophagus? |
|
Definition
|
|
Term
| What is the tx for GERD w/ mild, intermittent sx? |
|
Definition
| Antacids or H2 receptor antagonists PRN |
|
|
Term
| What is the tx for GERD w/ moderate sx? |
|
Definition
| H2 receptor antagonist bid or proton pump inhibitor qd |
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|
Term
| What is the tx for GERD w/ severe sx or erosive dz? |
|
Definition
| Proton pump inhibitor qd to bid |
|
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Term
| The tx for what complication of GERD includes dilation? |
|
Definition
| Peptic esophgeal stricture |
|
|
Term
| What are the 3 goals of tx for GERD? |
|
Definition
| 1)Sx relief 2)Heal esophagitis if present 3)Prevent complications |
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|
Term
| A break in the gastric or duodenal mucosa through the muscularis. |
|
Definition
|
|
Term
| How big are peptic ulcers typically? |
|
Definition
|
|
Term
| What is the hallmark sx of PUD present in 80-90% of pts? |
|
Definition
| Epigastric pain (dyspepsia) |
|
|
Term
| Describe the pain experienced by people w/ PUD. |
|
Definition
| Pain is localized to epigastrium, not severe, and described as gnawing, dull, aching, or "hunger-like" |
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|
Term
| What 2 additional sx are reported by pts w/ gastric ulcers? |
|
Definition
|
|
Term
| What are the 3 major etiologic agents that cause PUD? |
|
Definition
| 1)NSAIDs 2)Chronic H. pylori infxn 3)Acid hypersecretory states |
|
|
Term
| What types of NSAIDs can reduce the risk of dev. PUD? |
|
Definition
|
|
Term
| What is the diagnostic test of choice for PUD? |
|
Definition
|
|
Term
| Which require bx, gastric or duodenal ulcers? |
|
Definition
| Gastric ulcers. Duodenal ulcers are rarely malignant. |
|
|
Term
| What lab finding suggests ulcer penetration or perforation? |
|
Definition
|
|
Term
| What is the tx for PUD d/t H. pylori? |
|
Definition
| Macrolide abx and acid-antisecretory agent (proton pump inhibitor) |
|
|
Term
| What is the tx for PUD d/t NSAIDs? |
|
Definition
| Stop NSAID use if possible and acid-antisecretory agents (long-term proton pump inhibitors if unable to d/c NSAIDs) |
|
|
Term
| Name 4 complications of PUD. |
|
Definition
| 1)GI bleeding 2)Ulcer perforation 3)Ulcer penetration 4)Gastric outlet obstruction |
|
|
Term
| What causes Zollinger Ellison Syndrome (Gastrinoma)? |
|
Definition
| Gastrin-secreting tumor resulting in gastric acid hypersecretion |
|
|
Term
| What portion of gastrinomas are malignant? |
|
Definition
| 2/3 (1/3 have already metastasized to the liver at initial presentation) |
|
|
Term
| What % of pts w/ gastrinoma develop peptic ulcers? |
|
Definition
|
|
Term
| What condition is common in gastrinoma and what portion of pts have diarrhea? |
|
Definition
|
|
Term
| When would you need to screen for gastrinoma in a pt w/ PUD? (4) |
|
Definition
| 1)Ulcers are refractory to tx 2)Multiple or giant ulcers 3)Ulcers w/ hypercalcemia 4)H pylori (-) |
|
|
Term
| What lab findings are diagnostic for gastrinoma? |
|
Definition
| Elevated fasting serum gastrin levels and gastric pH <3.0 |
|
|
Term
| What is necessary to ensure accuracy of testing for gastrin levels in a pt suspected of having gastrinoma? |
|
Definition
| Stop H2 blockers X24hrs and/or PPIs X 6d |
|
|
Term
| What imaging studies are used to dx gastrinoma? |
|
Definition
| Somastatin receptor scintigraphy (SRS) w/ SPECT for total body imaging or endoscopic US for small gastrinomas |
|
|
Term
| What is the tx for localized gastrinoma? |
|
Definition
| Curative resection is possible only b/f mets to liver occurs |
|
|
Term
| Most gastric epithelial polyps are _____ and do not require tx. |
|
Definition
|
|
Term
| 10-20% of gastric epithelial polyps are _________ requiring removal d/t their premalignancy nature. |
|
Definition
|
|
Term
| What are the typical s/sx of early gastric CA? |
|
Definition
| Typically asymptomatic until later dz |
|
|
Term
| Name 4 typical presenting sx in pts w/ gastric CA. |
|
Definition
| 1)Dyspepsia 2)Vague epigastric pain 3)Anorexia and early satiety 4)Wt loss |
|
|
Term
| Ulcerating lesions in gastric CA can lead to what? |
|
Definition
| Acute GI bleeding w/ hematemesis or melena |
|
|
Term
| What diagnostic study is confirmatory for dx of gastric CA? What test is an accceptable alternative but may not detect small lesions? |
|
Definition
| Endoscopy. Barium upper GI series. |
|
|
Term
| What lab findings may occur in a pt w/ gastric CA d/t chronic blood loss? |
|
Definition
| Iron deficiency or anemia of chronic disease |
|
|
Term
| What test can be done for gastric CA to detect mets? What test is done to check for depth of tumor and nodal mets? |
|
Definition
| CT of chest and abd. EUS. |
|
|
Term
| What is the most common CA worldwide other than skin CA? Describe the current trend of this CA in the US. |
|
Definition
| Gastric adenocarcinoma. Rate is decreasing in US. |
|
|
Term
| What is the typical age of onset of gastric CA? What gender is it more common in? |
|
Definition
|
|
Term
| What ethnic groups have higher rates of gastric CA? |
|
Definition
|
|
Term
| What is a major risk factor in the dev. of gastric CA? |
|
Definition
| Chronic H. pylori infection |
|
|
Term
| What is the staging system used for gastric CA to det. tx options and prognosis? |
|
Definition
| TNM system(T=extent of primary tumor, N=nodal mets, M=distant mets) |
|
|
Term
| What is the tx for a localized tumor in gastric CA? For local invasion? |
|
Definition
| Resection. Resection + chemo/XRT |
|
|
Term
| What is the tx for gastric CA w/ mets? |
|
Definition
| Palliative tx only w/ resection, chemo/XRT |
|
|
Term
| What is the overall long-term survival rate of gastric CA? What is the survival rate for successful curative resection? |
|
Definition
|
|
Term
| What is the avg. age of onset of esophageal CA? Which gender is esophageal CA more common in? |
|
Definition
|
|
Term
| What are the 2 types of espophageal CA? |
|
Definition
| Squamous cell CA and adenocarcinoma |
|
|
Term
| What lifestyle factors are associated w/ squamous cell CA of the esophagus? |
|
Definition
|
|
Term
| What conditions are associated w/ esophageal adenocarcinoma? |
|
Definition
| Barrett's esophagus and obesity |
|
|
Term
| What % of pts w/ esophageal CA have dysphagia? What other sx is common? |
|
Definition
|
|
Term
| What is a common lab finding in pts w/ esophgeal CA? |
|
Definition
|
|
Term
| What test is diagnostic for esophageal CA? |
|
Definition
|
|
Term
| What is the overall 5yr survival rate for esophageal CA? |
|
Definition
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