Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

618 Gastropathy

tests

Basic Studies: Blood

■CBC

■If elevated MCV:

➣Vitamin B12 level

➣Schilling test or anti-parietal antibody levels

■Serum gastrin level to exclude Zollinger-Ellison syndrome

■H. pylori antibody useful in the setting of suspected peptic ulcer

disease or documented lymphoma

■Hypoalbuminemia and low serum protein in Menetrier’s disease

Upper Endoscopy with Biopsy

■Mucosal biopsies or urease testing for H. pylori

■False negative urease test can be seen with proton pump inhibitor

usage or high dose H2-receptor antagonist therapy

■Endoscopic appearance can be non-specific

■Histologic evidence of gastritis necessary to establish diagnosis

■Tissue for culture if clinically indicated

■In the setting of suspected Menetrier’s disease, perform endoscopic

mucosal resection to achieve depth required to confirm diagnosis

■Consider endoscopic ultrasound to exclude malignancy

Imaging

■Thickened gastric folds can be demonstrated and are nonspecific

■Small bowel study may be useful to exclude Crohn’s disease with

gastric involvement

differential diagnosis

Erosive/hemorrhagic gastritis

■Stress lesions in intensive care unit or burn patients

■Drugs: NSAIDS, potassium chloride, iron, chemotherapy, cocaine

■Alcohol

➣Gastritis

➣Portal hypertensive gastropathy in setting of cirrhosis

■Localized gastric trauma

➣Interventional, caustic, radiation, foreign body ingestion

■Reflux injury

➣Postgastrectomy, duodenogastric reflux

■Ischemia

■Graft-versus-host disease

■Prolapse gastropathy