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Transcript
Internal Medicine
•
ο
Gastric cancer
ο
Gastroparesis
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Gastritis
In up to 60% of dyspeptic patients no cause is identified (Functional or non ulcer
dyspepsia) - a condition most likely related to an abnormal perception of events
in the stomach caused by afferent visceral hypersensitivity.
Non gastritis mucosal Injury
1.
NSAIDS
• Acute ingestion: increases mucosal permeability and back diffusion
of H+ leading
to hyperemia, sub epithelial hemorrhage and superficial erosions.
• Chronic ingestion: inhibition of gastro duodenal mucosal prostaglandin synthesis
leading to decreased mucus and bicarbonate production and mucosal blood flow
finally resulting in frank ulceration may occur.
2.
Stress Related mucosal Damage
• Mucosal ischemia caused by decreased blood flow (from shock, Catecholamine
release) impairs mucosal resistance to acid back diffusion. Hyperemia of the
mucosa evolves & erosions and then frank ulceration in the stomach and duodenum
that go on to bleeding.
Clinical features
•
May be absent
•
Epigastric pain
•
Hemorrhage (hematemesis, melena)
Diagnosis – History of drug ingestion
•
Endoscopy
Treatment:
• Removal of offending agent.
• Antacids, H2-blokcer and surface acting agents (Sucralfate) are helpful.
• In patients with hemorrhage – Volume replacement and endoscopic control of the
bleeding.
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