1. Disease of Stomach Clinical - Sarm

• NSAID or steroid is one of the biggest cause of peptic ulcer disease
• peptic ulcer disease is due to injury from HCl and pepsin

  • break in mucosal surface - > 5 mm in size - with depth to submucosa
• ** the most common endpoint of helicobacter pylori infection is?

  chronic superficial gastritis
• helicobacter pylori can

  • develop atrophic gastritis
  • increase risk of gastric cancer
• How to diagnosis H. pylori?

  • serological tests - measure IgG antibodies
  • breath test - pt given urea - CO2 is measured
  • fecal antigen test - detect H. pylori antigen in feces
• What test can not be used to monitor H. pylori infection?

  serological test - bc IgG stays in the body for a while
• What is the best method to diagnose H. pylori?

  upper endoscopy (EGD) - histologic identification = gold standard
• most common factor that cause peptic ulcers disease?

  • NSAID
  • caffeine
  • steroid
• Gastric ulcer

  • aggravated by eating
  • weight loss
• duodenal ulcer

  • pain relieved by eating
  • weight gain
  • interrupts sleep
• Types of gastric ulcers

  • type 1 - located at the body of stomach
  • type 2 - gastric + duodenal ulcer
  • type 3 - pre-pyloric area
  • type 4 - located near cardia
  • * type 5 - any ulcers caused by NSAID
• Management of peptic ulcer disease - proton pump inhibitor

  • inhibit parietal proton pump
  • 100% acid neutralization
• Sucralfate - can be used as mucosal protective agents
• H. pylori eradication - drugs: is triple therapy

  • 4th drug that can be added - Bismuth
• Prophylaxis for peptic ulcer disease - Miso (misoprostol)

  • be careful - can cause abortion
• surgery can cause more complications in the management of peptic ulcer disease

  • can cause
  • bleeding
  • perforation
  • gastric outlet obstruction
• What is the most common cause of upper GI bleeding?

  bleeding peptic ulcers
• Bleeding peptic ulcers disease major risk factor?

  NSAID
• The 2 most common cause of GIT bleeding is?

  • peptic ulcers
  • gastritis
• melena - black tarry stool

  • associated with upper GI bleeding
• hematochezia - red bloody stool

  • associated with lower GI bleeding
• Bleeding peptic ulcers - early endoscopy is important

  • bipolar electrical or thermal coagulation
  • injection of EP
• gastric outlet obstruction occurs in pyloric stenosis in infants

  • OLIVE in left upper gastric area
• gastric outlet obstruction (GOO) - occur

  • chronic scarring as a complication of recurrent infection of peptic ulcer disease (PUD)
  • acute due to cancer with inflammation and edema
• Gastric outlet obstruction (GOO) - diagnosis

  • barium swallow
  • endoscopy with biopsy - to rule out malignancy
• what is the first goal in treating pts with gastric outlet obstruction?

  fluid and electrolyte replacement
• Treatment of gastric outlet obstruction?

  H2 blocker
• ** Posterior penetrating ulcer may cause pancreatitis
• perforation is ulcers penetrating through full thickness of wall of stomach or duodenum
• perforation can produce

  • peritonitis
  • if untreated - sepsis and death
• pt with perforation will present with?

  sudden acute abdominal pain
• ** perforation finding

  • board-like abdominal
  • pneumoperitoneum on upright CXR
• gastritis - nonspecific inflammation of the gastric mucosa
• 3 causes of gastritis

  1. H pylori
  2. NSAID
  3. stress
• NSAID induced gastritis

  • mucosal erosion
  • hyperemia
  • submucosal hemorrhage
• acute gastritis - caused by H pylori

  • leads to diffuse gastritis
• acute gastritis symptoms

  • sudden epigastric pain
  • N/V
• chronic gastritis - histologically - lymphocyte and plasma cells

  • patchy gastritis
• gastritis symptoms

  • dehydration
  • bleeding
  • anemia - bleeds a lot
• stress related gastric mucosal damage

  • prophylaxis regimen - titrate intra-gastric pH to 4