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General Surgery > Gastro-duodenal disorders > Flashcards

Gastro-duodenal disorders Flashcards

1
Q

Define peptic ulcer disease (PUD)

A

Gastric and duodenal ulcers

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2
Q

What is the commonest cause of peptic ulcer disease?

A

H. pylori infection (95% of duodenal, 80% of gastric)

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3
Q

What type of bacteria is H. pylori?

A

Gram -ve aerophillic helicobacter

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4
Q

How can H. pylori infection be detected?

A

Urease breath test

Histology

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5
Q

Describe the pathogenesis of H. pylori induced peptic ulcer disease

A

H. pylori converts urea to ammonia ➔ neutralises stomach pH and is toxic to epithelium

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6
Q

Outline the treatment for H. pylori

A

Triple therapy BD for 7 days

  • Omeprazole or lansoprazole
  • Clarithromycin 500mg
  • Amoxicillin 1g

or

  • Omeprazole or lansoprazole
  • Clarithromycin 250mg
  • Metronidazole 400mg
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7
Q

How can peptic ulcers be classified?

A

Gastric ulcers (Type I, body and fundal)
Duodenal ulcers
Gastric ulcers (Type II, prepyloric)
Atypical ulceration

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8
Q

Who tends to get gastric ulcers, and where are they most commonly located?

A

Elderly (M>F 3:1)

Lesser curve of the stomach

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9
Q

Name 3 risk factors for gastric ulceration

A 
H. pylori (80%)
High alcohol intake
Smoking
NSAIDs
Reflux of duodenal contents
Normal or low acid secretion
Delayed gastric emptying
Stress
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10
Q

Describe the symptoms of gastric (type I) ulceration

A

Asymptomatic
Epigastric pain (burning shortly after meals)
Weight loss
Anorexia

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11
Q

Describe the epidemiology of duodenal and gastric (type II) ulceration

A

M>F 5:1

Peak age 25-30yrs

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12
Q

Name 3 risk factors for duodenal ulceration

A 
H. pylori (90%)
NSAIDs, steroids, SSRIs
High acid secretion
Increased gastric emptying
Smoking
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13
Q

Describe the symptoms of duodenal ulceration

A

Asymptomatic (50%)
Epigastric pain (before meals or at night)
-Relieved by eating

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14
Q

Name 2 types of atypical peptic ulceration

A

Ectopic gastric mucosa in Meckel’s diverticulum

Zollinger-Ellison syndrome: non-beta islet cell gastrinoma of the pancreas

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15
Q

Differentiate between gastric and duodenal ulcerations

A

Gastric: Pain precipitated by food, weight loss, anorexia

Duodenal: Central back pain relieved by food, often occurs at night and early hours of morning

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16
Q

How is peptic ulcer disease investigated?

A 
Gastroscopy*
Barium meal
Urease breath test - detect H. pylori
Fasting serum gastrin levels - suspected hypergastrinaemia e.g. ZES
Hypercalcaemia
17
Q

Name 3 complications of peptic ulcer disease

A

Acute upper GI bleeding
Iron deficiency anaemia
Perforation
Gastric outlet obstruction

18
Q

Outline the management of peptic ulcer disease

A

Lifestyle: Alcohol and smoking cessation, avoid trigger foods, stress management

Medical: Avoid NSAIDs and aspirin, H. pylori eradication if needed, low-dose PPI or standard-dose H2RA, antacids

Surgical: Pyloroplasty +- selective vagotomy, partial gastrectomy

19
Q

What are the surgical indications for peptic ulcer disease?

A

Failure to respond to maximal medical treatment
Complications: bleeding, perforation, pyloric stenosis
Gastric outflow obstruction not responsive/suitable for balloon dilatation

20
Q

Name 3 causes of acute upper GI perforation

A

Duodenal ulceration
Gastric ulceration (usually anterior prepyloric)
Gastric carcinoma
Traumatic injury
Ischaemia (usually secondary to gastric volvulus)

21
Q

Name 3 symptoms seen in acute upper GI perforation

A

Acute onset upper abdominal pain
-Severe constant pain that worsens with breathing and movement, may radiate to back or shoulders
Prodrome of upper abdominal pain ➔ ulceration
Copious vomiting and distension ➔ volvulus
Prodromal weight loss, dyspepsia, anorexia ➔ carcinoma

22
Q

Name 3 signs seen in acute upper GI perforation

A

Generalised peritonism: washboard rigidity, guarding, tenderness, Rovsing’s sign
Localised peritonism
Distension
Systemic: mild fever, pallor, tachycardia, hypotension

23
Q

How can GI perforation be confirmed?

A

Erect CXR for pneumoperitoneum

CT scan

24
Q

Outline the definitive management of upper GI perforation

A

Duodenal ulcer ➔ Omental patch + H. pylori eradication, partial gastrectomy +- vagotomy if recurrent
Gastric ulcer ➔ Omental patch if prepyloric (type II), local excision and sutured closure if body (type I)
Gastric carcinoma ➔ Partial gastrectomy
Traumatic ➔ Sutured closure
Ischaemic volvulus ➔ Subtotal gastrectomy

25
Q

When is conservative management of upper GI perforation appropriate?

A

Patient declines surgery
Patient unlikely to survive surgery
Haemodynamically stable with small perforation (sealed at presentation) and no signs of peritonism

26
Q

Outline conservative management of upper GI perforation

A

IV PPI
Limited oral intake
Active physiotherapy
H. pylori eradication

27
Q

Describe the epidemiology of gastric cancer

A

5th commonest cancer in the world

3rd leading cause of cancer death worldwide

28
Q

Name 3 types of gastric cancer

A 
Adenocarcinoma*
Leiomyosarcoma
GI stromal tumour
Carcinoid tumour
Lymphoma
29
Q

Describe the epidemiology of gastric adenocarcinoma

A

Commonest age >50s (95% occur in over 55s)

M>F 3:1

30
Q

List 35risk factors for gastric cancer

A 
Increasing age esp >45
Male
H. pylori
Diet: rich in nitrosamines, low in fruit and veg
Smoking
Chronic atrophic gastritis
Family history
Blood group A (RR 1.2)
31
Q

Name 4 symptoms of gastric cancer

A 
Dyspepsia
Weight loss, anorexia, and lethargy
Abdominal pain
Iron deficiency anaemia
Upper GI bleeding
Dysphagia (uncommon unless involving gastro-oesophageal junction)
32
Q

Name 2 signs of gastric cancer

A

Weight loss
Palpable epigastric mass
Troisier’s sign (palpable left supraclavicular LN) ➔ metastases

33
Q

How is gastric cancer investigated?

A

FBC and LFTs
Endoscopy
Barium swallow

34
Q

Where does gastric cancer commonly metastasise?

A 
Lungs
Liver
Lymph nodes
Oesophagus
(Krukenberg tumour of the ovaries)

Indicted by Troisier’s sign

35
Q

What is the prognosis of gastric cancer in the UK?

A

Majority of gastric cancers are metastatic or unresectable upon presentation.

36
Q

Outline the management of gastric cancer

A

Majority unfit for surgery, treatment is palliative chemo.

If deemed curable, treatment depends on staging:

  • Early: Radical gastrectomy, pre/post-op chemo
  • Advanced: Pre/post-op chemo

General Surgery (23 decks)

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