The NCCPA™ Gastroenterology and Nutrition PANCE Content Blueprint covers three topics under the category of gastric disorders
Patient will present as → a 37-year-old male with a history of daily NSAID use complaining of epigastric pain, nausea, vomiting, all worsened by eating. On physical examination, he is tender to palpation in the epigastrium. He admits to drinking approximately two beers per day.
Dyspepsia (belching, bloating, distension, and heartburn) and abdominal pain are common indicators of gastritis
1. Infection - H. pylori (most common)
2. Inflammation of the stomach lining (NSAIDS and Alcohol)
3. Autoimmune or hypersensitivity reaction (e.g. pernicious anemia)
Treatment and diagnosis: stop NSAIDs, empiric therapy with acid suppression 4-8 wks. of PPI
|Peptic ulcer disease||
Gastric ulcer: Patient will present with → abdominal discomfort that is worse with meals and gets better an hour or so later after eating.
Duodenal ulcer: Patient will present as → a 62-year-old female with complaints of epigastric pain and belching which improves when she eats food but gets worse a few hours after her meal. She said he has noticed a change in the color of her stool.
PUD is an ulcer of the upper GI tract mucosa involving the proximal duodenum (90%) and distal stomach (10%). There are 2 main types of ulcers duodenal and gastric
Duodenal ulcer (food classically decreases pain think Duodenum = Decreased pain with food)
Gastric ulcer (food classically causes pain)
Bleeding — Acute upper gastrointestinal hemorrhage is the most common complication of peptic ulcer disease
DX: Upper endoscopy is the most accurate diagnostic test for peptic ulcer disease
TX: All patients with peptic ulcers should receive antisecretory therapy with a proton pump inhibitor (PPI) (eg, omeprazole 20 to 40 mg daily or equivalent) for 4-8 weeks
ReelDx Virtual Rounds (Pyloric stenosis)
You are called to see a 6-week-old with two weeks of projectile vomiting and an olive-sized abdominal mass
Signs and Symptoms
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Patient will present as → a 6-week-old first-born baby boy with projectile vomiting after feedings over the last 24 hours. Mom says that he enjoys feeding, and even after he vomits, he appears eager and hungry. On physical exam, you palpate an olive-shaped mass in the epigastric region at the lateral edge right upper quadrant. Labs show blood pH 7.47 and potassium of 3.2 mmol/L. On a barium upper GI series report, the radiologist states a “string sign” is present.
Pyloric stenosis is a congenital condition where a newborn’s pylorus undergoes hyperplasia and hypertrophy, leading to obstruction of the pyloric valve which causes vomiting (that might be projectile), as well as dehydration and metabolic alkalosis
Projectile vomiting occurs shortly after feeding in an infant < 3 mo. old with a palpable “olive-like” mass at the lateral edge of the right upper quadrant
DX: Diagnosis is by ultrasound
TX: surgical correction - pyloromyotomy (Ramstedt's procedure)
|Acute abdomen is a general term used to describe any patient condition that involves sudden onset and severe abdominal pain. There are many conditions that may or may not require emergent surgery to treat, which is why it is important to be able to quickly identify the cause. It can be helpful to sort the causes of acute abdomen into the classically defined region of abdominal pain. Pain can manifest in any location in cases of bowel obstruction, peritonitis, mesenteric ischemia, and strangulation.|
|The causes within the right upper quadrant (RUQ) include cholecystitis, biliary colic, cholangitis, perforated duodenal ulcer, and acute hepatitis. The causes within the left upper quadrant (LUQ) include splenic rupture and irritable bowel syndrome in conjunction with splenic flexure syndrome.|
|>||Midepigastric pain can be due to pancreatitis, aortic dissection, peptic ulcer disease, and myocardial infarction.|
|Causes within the lower quadrants include ovarian torsion, ectopic pregnancy, pyelonephritis, renal calculi, and acute salpingitis. Appendicitis is most commonly associated with right lower quadrant (RLQ) pain, and causes within the left lower quadrant (LLQ) include sigmoid volvulus and sigmoid diverticulitis.|