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Alimentary System > Helicobacter Pylori and Gastric Disease > Flashcards

Helicobacter Pylori and Gastric Disease Flashcards

1
Q

what is dyspepsia?

A

pain or discomfort in the upper abdomen

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2
Q

what symptoms does dyspepsia include?

A 
> upper abdominal discomfort
> retrosternal pain
> anorexia
> nausea
> vomiting
> bloating
> fullness
> early satiety
> heart burn
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3
Q

what are upper gi causes of dyspepsia?

A

> peptic ulcer
gastritis
non-ulcer dyspepsia
gastric cancer

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4
Q

what are lower causes of dyspepsia?

A

> IBS

> colonic cancer

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5
Q

how may the gall bladder cause dyspepsia?

A

formation of gallstones

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6
Q

what systemic problems may cause dyspepsia?

A

> cardiac
drugs
psychological

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7
Q

in dyspepsia when would you refer for an endoscopy?

A 
Anorexia
Loss in weight
Anaemia
Recent onset >55 years
Melaena/haematemesis
Mass
Swallowing problems (dysphagia)
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8
Q

what are the risks associated with upper gi endoscopy?

A

> 1:2000 risk perforation
bleeding
drug reaction

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9
Q

what blood tests are carried out in dyspepsia?

A 
> fbc
> ferritin
> lft's
> u and e's
> calcium
> glucose
> ceoliac serology/serum iga
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10
Q

what would you look for in a drug history in patients with dyspepsia?

A 
> nsaids
> steriods
> biphosphonates
> calcium antagonists
> nitrates
> throphyllines
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11
Q

if a patient who is over 55 prsents with dyspepsia what would you carry out?

A

an upper gi endoscopy

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12
Q

a patient who is less than 55 present with dyspepsia. what test would you carry out?

A

test for helicobacter pylori

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13
Q

if the helicobacter pylori test is positive what is your next step?

A

eradication therapy and symptomatic treatment with PPIs or H2R antagonists.
if symptoms resist refer them to GI

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14
Q

describe the helicobacter pylori bacterium

A

> gram negative
spiral shaped
microaerophilic
flagellated

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15
Q

how much of the world population is infected with helicobacter pylori?

A

50%

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16
Q

where does h. pylori colonise?

A

surface layer of gastric type mucosa. does not penetrate the epithelial layer.

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17
Q

what does h. pylori invoke in the underlying mucosa?

A

host immune response

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18
Q

what are the clinical outcomes of h. pylori?

A 
> asymptomatic
> chronic gastritis
> chronic atrophic gastritis
> intestinal metaplasia
> gastric/duodenal ulcers
> gastric cancer
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19
Q

what can the outcome of h. pylori depend on?

A

> site of colonisaton
characteristics of bacteria
host factors: genetics and enviroment

20
Q

what are the effects of antral dominant gastritis?

A

> increase in acid
low risk of gastric ca
duodenal disease

21
Q

what is the effect of a chronic h. pylori infection that leads to mild mixed gastritis?

A

this leads to normal acid production and no significant disease

22
Q

what is the effect of corpus predominant gastritis from chronic h. pylori infection?

A

> decrease in acid
gastric atrophy
leading to gastric ca

23
Q

how would you non-invasively diagnose h. pylori infection?

A

> serology: IgG
urea breath test
stool antigen test (need to be off ppi for 2 weeks)

24
Q

how may you invasivley diagnose h. pylori infection?

A

through and endoscopy.
> histology of gastric biopsies
> culture of gastric biopsies
> rapid slide urease test

25
Q

what carbon atoms are used in urease dependent diagnosis?

A

c13 and c14

26
Q

what is measured in breath tests to indicate h. pylori positive?

A

c13 or c14 labelled co2

27
Q

what is utilised in slide urease tests for h. pylori diagnosis?

A

> ammonia

28
Q

define gastritis

A

inflammation of gastric mucosa

29
Q

what are the causes of gastritis?

A

> autoimmune (parietal cells)
bacterial (H. pylori)
chemical (NSAIDs/bile)

30
Q

what are the majority of peptic ulcers caused by?

A

h. pylori infection

31
Q

what can cause peptic ulcers?

A

> h. pylori infection
NSAIDs
smoking

32
Q

what are some rare causes of peptic ulcers?

A

> zollinger-ellison syndrome
hyperparathyroidism
crohn’s disease

33
Q

name some symptoms associated with peptic ulcers

A 
> epigastric pain
> nocturnal pain
> back pain
> nausea (vomiting)
> weight loss
> epigastric tenderness
> bleeding: haematemesis, melaena, anaemia
34
Q

how would you treat an ulcer caused by h. pylori?

A

eradication therapy

35
Q

how may you treat a peptic ulcer?

A

> proton pump inhibitors
h2 antagonists
stopping nsaids if possible (or continued to recieve other protective agents following eradication therapy)

36
Q

describe eradication of h. pylori infection

A

triple therapy for 7 days:
> clarithromycin 500mg bd
> amoxicillin 1g bd
> PPI (omeprazole) 20mg bd

37
Q

what are the main reason eradication of h. pylori fails?

A

> resistance to antibiotics

> poor compliance

38
Q

what are the complications of a peptic ulcer?

A 
> acute bleeding
> chronic bleeding
> perforation
> fibrotic stricture
> gastric outlet obstruction
39
Q

describe the vomit in gastric outlet obstruction

A

> lacks bile

> fermented food stuffs

40
Q

what are the symptoms id gastric outlet obstruction?

A 
> early satiety
> abdominal distension
> weight loss
> gastric splash
> dehydration
41
Q

why is dehydration an effect of gastric outlet obstruction?

A

there is loss of h+ ions and cl- ions in the vomit

42
Q

what changes would be seen in bloods in gastric outlet obstruction?

A

> low cl
low na
low k
renal impairment

43
Q

how would you diagnose gastric outlet obstruction?

A

UGIE: prolonged fast then aspiration of gastric contents. identifies cause

44
Q

how may gastric cancer patients present?

A 
> dyspepsia
> early satiety
> nausea
> weight loss
> gi bleeding
> iron deficiency
> anaemia
> gastric outlet obstruction
45
Q

why would you carry out endoscopy’s and biopsies in a patient with gastric cancer?

A

to make a histological diagnosis

46
Q

what staging investigations might you carry out with gastric cancer?

A

> ct chest/abdomen

47
Q

who would be present in an MDT discussion about a patient with gastric cancer?

A 
> gastroenterologist
> pathologist
> radiologist
> upper gi surgeons
> oncologists
> specialist nurses

Alimentary System (33 decks)

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