Diseases of the Stomach + Duodenum

Question 1

Inflammation causing mucosal injury of the stomach

Answer 1

Gastritis

Question 2

What is acute gastritis

Answer 2

Acute gastritis

Question 3

What does the autoimmune gastritis?

Answer 3

Affects funds and body, antibodies destroy parietal cells and intrinsic cells –> leads to gastric atrophy

Question 4

What can autoimmune gastritis lead to?

Answer 4

Pernicious anaemia, metaplasia

Question 5

What is chronic gastritis cause by?

Answer 5

Chemicals (NSAIDs, alcohol, bile reflux), bacterial infection (H.pylori), autoimmunity

Question 6

What can chronic gastritis lead to?

Answer 6

Gastric ulcers

Question 7

What is gastroparesis?

Answer 7

Non-obstructive, delayed gastric emptying

Question 8

Symptoms of gastroparesis

Answer 8

Fullness, bloating, weight loss, nausea, vomiting, abdo pain

Question 9

Investigations of gastroparesis

Answer 9

Oesophageal manometry

Question 10

Treatment of gastroparesis

Answer 10

1. Removal of factors
2. Liquid diet
3. Nutritional support
4. Gastric pacemaker

Question 11

Types of gastric cancer

Answer 11

Adenocarcinoma, GISTs, MALTomas

Question 12

Where does adenocarcinoma affect?

Answer 12

Proximal - cardia/GO junction

Question 13

What causes adenocarcinomas?

Answer 13

H.pylori

Question 14

Progression of H.pylori to carcinoma

Answer 14

h.pylori –> chronic gastritis –> metaplasia –> dysplasia –> carcinoma

Question 15

Types of adenocarcinomas

Answer 15

Type I and type II

Question 16

Type I adenocarcinoma

Answer 16

Intestinal - polypoid mass

Question 17

Type II adenocarcinoma

Answer 17

Diffuse - expansive, infiltrative mass

Question 18

GIST usual age

Answer 18

55-65

Question 19

What causes GIST

Answer 19

Defect of pacemaker cells (ICCs)

–> mesenchymal tumour

Question 20

What do MALTomas primarily involve?

Answer 20

B-cells in lymph nodes

Question 21

What is peptic ulcer disease?

Answer 21

Breach of GI mucosa by acid/pepsin attack

Question 22

Where is peptic ulcer disease more common?

Answer 22

Developing countries

Question 23

Relieved by eating

Answer 23

Duodenal ulcers

Question 24

Exacerbated by eating

Answer 24

Gastric ulcers

Question 25

Symptoms of peptic ulcer disease

Answer 25

Burning epi pain, loss of appetite and weight, fullness, nausea, dyspepsia, increased acid, reflux

Question 26

Causes of peptic ulcer

Answer 26

H.pylori, NSAIDs, smoking/chemical irritants

Question 27

Investigations of H.pylori

Answer 27

Stool antigen, C13 urease breath test, serology (IgG)

Question 28

When H.pylori -ve…?

Answer 28

Do endoscopy to exclude cancer

Question 29

Treatment of peptic ulcer disease

Answer 29

1. Antacids, H2 antags, PPIs

2. H. pylori eradication

Question 30

H. pylori eradication therapy

Answer 30

2 weeks:
OMEPRAZOLE + AMOXICILLIN + CLARITHROMYCIN
(amoxicillin/metronidazole if pen allergic)

Question 31

If triple therapy fails?

Answer 31

Stop PPIs for 2 weeks and retry

Try metroclopramide or bismuth chelate