Gastrointestinal GASTRIC DISEASE Medicine, Surgery Se Fico nian 2 General: Gram negative gastric bacteria that is associated with gastritis and PUD Diagnosis: - If upper endoscopy is indicated: Biopsy with urease testing + culture - Noninvasive Testing: - Stool antigen assay - Urea breath test - Serology is avoided (low spec/sens, does not differentiate active from previous infection) Management: - Triple Therapy (First Line): Amoxicillin, Clarithromycin, PPI - Quad Therapy: Metronidazole, Tetracycline, PPI, Bismuth - Used if local macrolide resistance - After treatment, test for eradication (same tests as diagnosis) General: Mechanical obstruction of the gastric outlet Etiology: - Peptic ulcer disease (causes scar formation) - Caustic ingestion (stricture) - Malignancy - Gastric bezoar (accumulation of ingestion material, like hair) Clinical: Nausea/vomiting, epigastric pain, early satiety, abdominal distension - Succussion splash: Hear gastric contents splash > 3 hours after eating Diagnosis: CT or Endoscopy Management: NPO, NG tube decompression, PPI - Treat underlying (surgically remove masses, dilate strictures, etc) a es Gastroparesis General: Delayed gastric emptying without mechanical obstruction Etiology: Diabetes, postsurgical Clinical: Presents with nausea, vomiting, early satiety, epigastric pain Diagnosis: Gastric emptying study Management: Glycemic control/hydration, prokinetics (metoclopramide), antiemetics . : eer esas : Dieulafoy's Lesion: Dilated submucosal blood vessel that, in the absence of ulceration, invades through the gastric mucosa. Rare cause of upper Gl bleed. Menetrier Disease: Rare acquired stomach disease in wl results in rugal hypertrophy. Can cause chronic epigastric pai vomiting. May have increased cancer risk. astric hyperplasia weight loss, nausea, Glo oF