GIGU Gastric & Small Intestine

What bacterium is a primary cause of gastritis, peptic ulcers, and gastric cancer?

Helicobacter pylori (H. pylori)

What is the gold standard for confirming gastric conditions?

Endoscopic testing

What syndrome can result from medications used for gastric conditions and GERD causing hypercalcemia?

Milk-alkali syndrome (Burnett’s syndrome)

In adults, gastric outlet obstruction most commonly occurs due to what?

Scarring from chronic peptic ulcers or gastric cancer

What congenital condition can cause gastric outlet obstruction in infants?

Pyloric stenosis

Which gastric condition discussed is considered functional instead of pathological?

Rumination syndrome

What term is commonly used to describe epigastric pain or discomfort?

Dyspepsia

How may gastric pain be described?

Gnawing, burning, or “hunger pains”

Severe, rapid-onset gastric pain may indicate what life-threatening emergency?

Peritonitis

What post-prandial symptoms are common with gastric disorders?

Bloating, fullness after meals, and early satiety

What does early satiety mean?

Feeling full after consuming only a small amount of food

What GI symptoms are commonly associated with gastric conditions?

Anorexia, nausea, vomiting, regurgitation, and belching

Why may patients with gastric conditions lose weight?

Fear of eating due to pain (sitophobia) or malignancy

What is dyspepsia?

A recurrent or intermittent pain/discomfort in the upper abdomen

Can dyspepsia be functional or pathological?

Yes

What is nausea?

The subjective feeling of the need to vomit

What is vomiting?

Forceful expulsion of gastric contents

What is retching?

Forceful, rhythmic respiratory and abdominal movements without expulsion of contents

What is another term for retching?

Dry heaving

What is regurgitation?

Unintentional, non-forceful spitting up of food or liquid without nausea

What is a perforation?

A hole through the stomach or intestinal wall releasing contents into the peritoneum

What gastric conditions are leading causes of perforation?

Gastritis and peptic ulcers

How does perforation typically present?

Sudden severe abdominal pain and signs of shock

What is the correct action for suspected perforation?

Immediate referral to emergency services (911)

What is peritonitis?

Inflammation of the peritoneum often following perforation

Why is peritonitis dangerous?

It is a life-threatening surgical emergency

What is hematemesis?

Vomiting blood

Bright red hematemesis indicates what?

Active, brisk bleeding

What does coffee-ground hematemesis indicate?

Slow or stopped bleeding with partially digested blood

What is melena?

Dark, tarry, jelly-like stools from digested blood

What are common causes of upper GI bleeding?

Gastritis, peptic ulcers, esophageal varices, Mallory-Weiss tears, and cancer

What medication use is a significant risk factor for upper GI bleeding?

NSAID use

What complications can chronic gastric conditions lead to?

Dehydration, malnutrition, and anemia

What is rumination syndrome?

A functional disorder involving repeated unintentional regurgitation of undigested or partially digested food

What happens to food during rumination syndrome?

It is re-chewed and re-swallowed or spit out

Rumination syndrome is often compared to what animal behavior?

A cow chewing its cud

What age groups can develop rumination syndrome?

Infants, children, adolescents, and adults

What is believed to cause rumination syndrome?

A learned maladaptive habit involving GI sensitivity and muscle contractions often triggered by stress

What key clinical feature differentiates rumination syndrome from many gastric disorders?

Absolute absence of pain

How is rumination syndrome diagnosed?

Clinically using Rome Criteria

What is the treatment for rumination syndrome?

Diaphragmatic breathing techniques

How does H. pylori survive stomach acid?

It buries itself in the stomach lining

Approximately what percentage of the global population has H. pylori?

50%

By age 60, about what percentage of individuals in the U.S. are infected with H. pylori?

50%

Which populations have higher rates of H. pylori infection?

African-American, Asian, and Hispanic populations

How is H. pylori transmitted?

Fecal-oral or oral-oral transmission

What living conditions increase risk for H. pylori?

Crowded conditions such as nursing homes

What occupations increase risk for H. pylori exposure?

Working in GI medicine

What gastric conditions is H. pylori most associated with?

Gastritis and peptic ulcers

H. pylori is a risk factor for what cancer?

Gastric cancer

What anemia is linked to H. pylori?

Unexplained iron deficiency anemia

What test detects exhaled labeled carbon after ingestion of urea for H. pylori diagnosis?

Urea breath test

What does the stool test for H. pylori detect?

Antigens

What does the blood test for H. pylori detect?

Antibodies

How is biopsy for H. pylori obtained?

Via endoscopy

What therapies are used to treat H. pylori?

Triple or quadruple therapy with antibiotics and PPIs or H2 blockers

What percentage of H. pylori cases recur if not properly eradicated?

10–20%

What is gastritis?

Inflammation, irritation, or infection of the stomach lining

How is gastritis classified by timing?

Acute or chronic

How is gastritis classified by severity?

Erosive or non-erosive

What are causes of erosive gastritis?

NSAIDs, alcohol, chronic vomiting, and severe stress

What clinical signs are common with erosive gastritis?

Hemorrhage and dyspepsia

What is the primary cause of non-erosive gastritis?

H. pylori

What complication can non-erosive gastritis cause?

Vitamin B12 deficiency anemia

What symptoms are common with gastritis?

Epigastric pain, bloating, anorexia, and halitosis

What is peptic ulcer disease (PUD)?

Deep erosion through the gastric or duodenal mucosa

How does a gastric ulcer typically present?

Pain occurs immediately after eating and is inconsistent

How does a duodenal ulcer typically present?

Pain occurs when stomach is empty and is relieved by food

When does duodenal ulcer pain commonly occur?

2–3 hours post-meal or at night

What are the major causes of peptic ulcer disease?

H. pylori and NSAIDs

NSAIDs cause approximately what percentage of peptic ulcer disease cases?

50%

What are risk factors for peptic ulcer disease?

Smoking, alcohol, female sex, and family history

What are complications of peptic ulcer disease?

Bleeding, perforation, and gastric outlet obstruction

What is Milk-alkali syndrome?

A triad of hypercalcemia, metabolic alkalosis, and renal insufficiency

What causes Milk-alkali syndrome?

Ingestion of large amounts of calcium and absorbable alkali

Why did Milk-alkali syndrome resurge after the 1980s?

Marketing of calcium products and vitamin D supplementation

What are symptoms of acute Milk-alkali syndrome?

Irritability, muscle aches, and vomiting

What is Cope’s syndrome?

The intermediate stage of Milk-alkali syndrome with conjunctival infection

What characterizes chronic Burnett’s syndrome?

Soft tissue calcification

What mnemonic is associated with hypercalcemia in Milk-alkali syndrome?

Bone, stones, groans, and psychiatric overtones

What lab findings suggest Milk-alkali syndrome?

Elevated serum calcium and vitamin D levels

What is gastric outlet obstruction (GOO)?

Any condition that impedes gastric emptying into the duodenum

What benign conditions can cause GOO?

Scarring from peptic ulcers and gastric polyps

What malignant conditions can cause GOO?

Gastric tumors, duodenal tumors, or pancreatic cancer compression

What are cardinal signs of gastric outlet obstruction?

Nausea, vomiting, weight loss, and dehydration

What is pyloric stenosis?

Congenital hypertrophy of the pyloric valve

At what age does pyloric stenosis usually appear?

3–12 weeks of life

Which sex is more commonly affected by pyloric stenosis?

Males

What type of vomiting is associated with pyloric stenosis?

Projectile vomiting

How does an infant with pyloric stenosis often behave after vomiting?

Hungry but unable to retain food

What sign of dehydration may be seen in pyloric stenosis?

Decreased wet diapers

What may be palpated on physical exam in pyloric stenosis?

An olive-shaped mass

Where is gastric cancer especially prevalent?

China and Japan

What is the primary risk factor for gastric cancer?

Chronic H. pylori infection

Why is gastric cancer often diagnosed late?

Symptoms are vague and develop slowly

What are common symptoms of gastric cancer?

Dyspepsia and early satiety

What dietary recommendations are suggested for gastric conditions?

Avoid trigger foods and alcohol, stop smoking, eat smaller meals, and maintain hydration

What lifestyle recommendations help gastric conditions?

Stress management and exercise

What supplements may be recommended for gastric conditions?

L-glutamine, DGL licorice, Swedish bitters, ginger, and peppermint tea

Case: Acute pain after eating, high NSAID use, low pain scale, no reflux signs suggests what?

Gastritis