‌

GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review

‌‌

14,845views

00:00 / 00:00

‌‌
‌
‌
‌‌‌‌‌‌‌‌‌‌
‌
‌‌‌

Questions

USMLE® Step 1 style questions USMLE

of complete

A 62-year-old man presents to the emergency department with severe abdominal pain and vomiting this morning. He states he has had abdominal pain for the past several weeks, with the pain acutely worsening today with radiation to the left shoulder. He reports the vomit was dark brown and had a granular consistency. Past medical history is significant for hypertension and hypercholesterolemia. He was also admitted for alcoholic pancreatitis approximately six weeks ago.The patient has smoked 1 pack of cigarettes daily for 30 years. He reports drinking 3-4 beers daily. Temperature is 37°C (98.6 °F), pulse is 111/min, respirations are 24/min, and blood pressure is 92/62 mmHg. Physical examination shows a pale man in acute distress. Abdominal examination is notable for diffuse tenderness to palpation, with rebound and rigidity. Laboratory results are shown below:

 
Laboratory value  Result
 CBC, Serum 
 Hemoglobin  10.1  g/dL 
 Hematocrit  30% 
 Leukocyte count  14,000 /mm3 
 Platelet count  160,000/mm3 
 Serum
               Sodium  132 mEq/L 
           Potassium  4.2 mEq/L 
              Chloride  95 mEq/L 
                 BUN                    67 mg/dL  
             Creatinine  2.6 mg/dL 
              Albumin  3.7  g/dL 
                 AST  60 U/L 
                 ALT  30 U/L 
    Alkaline Phosphatase  110 U/L 
           Bilirubin, total  .7 mg/dL 
              Lipase  100 U/L 
Abdominal imaging is most likely to reveal which of the following findings?    

Memory Anchors and Partner Content

Transcript

Watch video only

Content Reviewers

Yifan Xiao, MD

A 61-year-old man, named Shawn, comes to the emergency department because of substernal chest pain and heartburn.

He mentions that his symptoms worsen typically after coffee, heavy meals or during times of stress.

He also feels the pain at night when he is lying in bed and has previously been woken from sleep by discomfort.

He has not noticed any dyspnea, diaphoresis, or palpitations but is currently experiencing some nausea and a sour taste in his mouth. Shawn also denies a history of previous cardiovascular conditions. His ECG is normal.

Shawn has gastroesophageal reflux disease, or GERD. GERD is a condition caused by a transient lower esophageal sphincter relaxation, which enables stomach contents and acid to re-enter esophagus and damage esophageal mucosa.

As a result, people with GERD present with symptoms such as retrosternal chest pain, heartburn, regurgitation, and dysphagia.

It’s important to note that GERD symptoms tend to worsen after eating, when lying down, or bending over.

Now, if stomach acid gets to the throat, it can cause laryngopharyngeal reflux, which has a different set of symptoms such as acidic taste in the mouth, sore throat, chronic cough, and hoarseness.

In the mouth, gastric acid can even damage tooth enamel. Finally, if inhaled, stomach acid can cause pneumonia and asthma.

GERD is commonly associated with conditions such as decreased esophageal motility, gastric outlet obstruction, and hiatal hernia.

Risk factors for GERD include lifestyle habits such as caffeine, alcohol, and smoking; use of some medications, such as antihistamines and calcium channel blockers; but also, obesity; pregnancy; and Zollinger-Ellison syndrome.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Gastroesophageal Reflux Disease" New England Journal of Medicine (2008)
  4. "Gastroesophageal Reflux Disease" New England Journal of Medicine (2008)
  5. "Barrett's oesophagus" The Lancet (2009)
  6. "Barrett's oesophagus and oesophageal adenocarcinoma: time for a new synthesis" Nature Reviews Cancer (2010)
  7. "Barrett's oesophagus: from metaplasia to dysplasia and cancer" Gut (2005)
  8. "Inflammation, atrophy, and gastric cancer" Journal of Clinical Investigation (2007)
  9. "Ménétrier disease and gastrointestinal stromal tumors: hyperproliferative disorders of the stomach" Journal of Clinical Investigation (2007)
  10. "MANAGEMENT OF PATIENTS WITH ZOLLINGER-ELLISON SYNDROME" Annual Review of Medicine (1995)
  11. "Guide to the Use of Proton Pump Inhibitors in Adult Patients" Drugs (2008)