Disorders of stomach and duodenum

Question 1

Disorders (7)

Answer 1

N+V
Hiatus hernia
Dyspepsia
Peptic ulcer

Gastroperesis

• small stomach syndrome
• dumping syndrome

Question 2

Emesis

Answer 2

Forceful expulsion of stomach contents

Question 3

N+V:

Causes

Answer 3

Stomach irritation
Radio-/chemo-therapy
Disease
Drug side effect

Question 4

Hiatus hernia

Answer 4

Abnormal bulging of portion on the stomach through diaphragm

Sliding or paraesophageal

Angle of gastro-oesophageal junction altered -> impaired reflux prevention

Question 5

Hiatus hernia:

Complications

Answer 5

Ulcers
Strictures
Barretts oesophagus

Question 6

Hiatus hernia:

Intervention

Answer 6

Weight loss
Avoid foods causing symptoms
Symptom relief of GORD - little + often, avoid fatty + spicy foods
Increase fibre + fluid for constipation

Question 7

Hiatus hernia:

Diagnosis

Answer 7

Barium swallow

Endoscopy

Question 8

Hiatus hernia:

Risk factors

Answer 8

Constipation
Overweight
Tight clothes
Pregnancy
Smoking
>50yr

Question 9

Dyspepsia

Answer 9

Indigestion

Symptoms not a disease

Question 10

Dyspepsia:

Symptoms

Answer 10

Bloating
Early satiety on eating
Abdo pain

Question 11

Dyspepsia:

Cause

Answer 11

GORD
Underlying disease
Poor eating habits

No cause of function dyspepsia

Question 12

Dyspepsia:

Treatment

Answer 12

Antacids
Rule out H. Pylori infection
Lifestyle advice

Question 13

Dyspepsia:

Alarm features of major pathology

Answer 13

Dysphagia
Constant vomiting
Unexplained weight loss
GI blood loss

Question 14

Peptic ulcer

Answer 14

Erosion in mucosal lining

Question 15

Peptic ulcer:

Treatment

Answer 15

Antibiotics

Healthy lifestyle + diet advice to minimise risk of recurrence

Question 16

Peptic ulcer:

Complications

Answer 16

Bleeding

Question 17

Peptic ulcer:

Causes

Answer 17

H. Pylori
NSAIDS
Hypersecretion of HCl

Question 18

Peptic ulcer:

Factors which exacerbate

Answer 18

Smoking
Stress
Irregular meals
Eating too quickly
Inadequate chewing

Question 19

Gastroperesis

Answer 19

Delayed gastric emptying w/o mechanical obstruction

Reduced peristaltic action due to

• loss gastric pacemaker cells
• vagus nerve disruption

Question 20

Gastroperesis:

Main causes

Answer 20

Idiopathic/unknown
DM
Post surgery

Question 21

Gastroperesis:

Symptoms

Answer 21

N+V
Abdo pain
Bloating
Early satiety
Weight loss

Question 22

Gastroperesis:

Diagnosis

Answer 22

Gastric emptying scintigraphy

• meal labelled with isotope
• x-ray images
• • if >60% meal residue after 2hr or >10% at 4hr

Question 23

Gastroperesis:

Nutritional consequences

Answer 23

Signs of malnutrition may be missed
Anorexia or decreased oral intake
Vomiting -> electrolyte imbalance
Poor glycaemic control in DM -> vascular complications

Question 24

Gastroperesis:

Treatment

Answer 24

Manage underlying cause, decrease symptoms and restore nutrition + hydration
Pharmacological
Gastric pacemaker
Surgery -> gastrectomy
Diet - little + often, decrease fat + fibre, modify texture?

Question 25

Gastroperesis: | Nutritional support

Answer 25

``` ONS = well tolerated NJ - if vomiting + not tolerating NG Continuous > bolus Fibre free Extreme -> parenteral ```

Question 26

Dumping syndrome (2)

Answer 26

Early | Late

Question 27

Dumping syndrome: | Early

Answer 27

Rapid gastric emptying Rapid weak pulse, sweating, faintness, hypertension Advice - decrease simple CHO, avoid liquid with meals, little + often

Question 28

Dumping syndrome: | Late

Answer 28

1-3hr after meal Over production of insulin in response to rapid glucose absorption Weak, faint, cold Advice - same, regular starchy CHOs

Question 29

Small stomach syndrome: | Symptoms

Answer 29

Decreased food intake Uncomfortable during/after eating Bloated Early satiety

Question 30

Small stomach syndrome: | Consequences

Answer 30

Weight loss | Nutritional deficiencies

Question 31

Small stomach syndrome: | Treatment

Answer 31

Little + often Increased nutrient dense meals Fluid separate from solid foods

Question 32

Small stomach syndrome: | Side effects

Answer 32

Diarrhoea Malabsorption Weight loss + undernutrition Bile vomiting