9.23 SFGH pearls: GI ulcers and bone malignancies!

  • The American College of Cardiology recommends ulcer prophylaxis with PPI for patients on dual antiplatelet therapy, have a history of PUD or GERD, on are steroids, or are over 60 – this patient met 3 of the 4 criteria
    • The American College of Gastroenterology has more conservative guidelines, suggesting PPI if they have a history of complicated PUD or 2 risk factors (>65, high dose NSAIDs, history of PUD, dual antiplatelet therapy, steroids or anticoagulants)
  • Mnemonic to remember the malignancies that metastasize to or involve the bones: BLT Sandwich with a Kosher Pickle and Light Mustard and Mayo
    • (B-breast, L-lung, T-thyroid, S-sarcoma, K-kidney, P-prostate, L-lymphoma, M-myeloma and melanoma)
  • Chloromas (also known as myeloid sarcomas and myeloblastomas) are extramedullary manifestations of AML or acute CML blast crises and can rarely be present in the GI tract and potentially cause GI bleed.
  • There are several types of stress gastritis/stress ulcers that share a common pathway of superficial erosions of the gastric mucosa starting in the proximal portion of the stomach and progressing distally. The erosions develop within hour of severe physiologic stress and can cause bleeding if they progress to involve the submucosa.
    • Cushing’s ulcers are associated with CNS injury àincreased vagal nerve stimulation à increased acid secretion
    • Curling’s ulcer are associated with burns >30% of body surface
    • Both types are most associated with perforation than other stress ulcers

Evernote link here: https://www.evernote.com/shard/s300/sh/20fcfab4-ed1b-48eb-8e14-1b04d4044ebb/b3a8a8395cb300505e4438f2adb82d86

Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2008; 52:1502.

Lanza FL, Chan FK, Quigley EM, Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol 2009; 104:728.

Byrd JC, Edenfield WJ, Shields DJ, Dawson NA. Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. J Clin Oncol 1995; 13:1800.

Lucas CE, Sugawa C, Riddle J, et al. Natural history and surgical dilemma of “stress” gastric bleeding. Arch Surg 1971; 102:266.

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