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Gastric conditions Flashcards

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1
Q

What is dyspepsia (7)

A 
AKA INDIGESTION
Is a collective name for a group of symptoms:
Upper abdo pain/retrosternal pain
Anorexia - appetite loss
Nausea
Vomiting
Bloating
Fullness/early satiety
Heartburn
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2
Q

When is an UGIE indicated (6)

A 
If they have ALARM features:
Anorexia 
Loss of weight
Anaemia - iron deficiency anaemia
Recent onset - >55yrs age
Melaena/haematamesis & Masses
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3
Q

What drugs can cause dyspepsia (7)

A 
NSAIDs
Steroids
Bisphosphonates
CCBs
Nitrates
Theophyllines
OTC
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4
Q

Peptic ulcer MOST COMMON cause

A

H. pylori infection

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5
Q

Duodenal ulcers are more likely caused by H. pylori infection but what are gastric ulcers more commonly caused by

A

NSAIDs

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6
Q

Peptic ulcer pathophysiology (2)
+ 2 types of peptic ulcers
+ is acid secretion high or normal or low in the respective types

A

Imbalance between acid secretion and level of mucous protection –> epithelial damage and subsequent mucosal/submucosal damage

DU - acid hyper secretion
GU - normal/low acid secretion

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7
Q

Peptic ulcer risk factors

A

H pylori infection
NSAIDs
Smoking

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8
Q

Peptic ulcer symptoms (5) + signs (1)

-location of pain + 3 characteristics of the pain

A

Symptoms:
Dyspepsia - epigastric pain
-pain worsen after eating in GU/better after eating in DU
-pain often worsens at night
-pain can radiate to back in DU perforated

Nausea + vomiting

Signs:
Epigastric tenderness

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9
Q

Peptic ulcer investigations (3)

A

Urea breath test/H.pylori faecal antigen test
UGIE
FBC (ordered if anaemic or evidence of GI bleed)

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10
Q

Peptic ulcer treatment (4)

  • if due to H. pylori (3)
  • medical measures (2)
  • triggers to avoid
  • when is surgery indicated
A

If caused by H. pylori then eradication therapy - amoxycillin (or metronidazole if penicillin allergic) + clarithromycin + omeprazole

PPI - omeprazole
OR Hydrogen receptor blocker - ranitidine

Stop NSAIDs if being used

Surgery if ulcer –> complicated peptic ulcer disease

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11
Q

Initial treatment for acute bleeding ulcer (2)

A

Blood transfusion

Endoscopic ligation

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12
Q

Complications of peptic ulcer (4)

A

Acute bleed (haemorrhage) - haematemesis (coffee ground vomit) or melaena

Chronic bleed - iron deficiency anaemia

Perforation - ulcer can erode through stomach wall into peritoneum –> peritonitis

Stricture –> gastric outlet obstruction

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13
Q

Where can you get peptic ulcers (3)

A

Lower oesophagus
Stomach (body and antrum)
Duodenum (1st/2nd part)

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14
Q

3 types of gastritis

A

Type A - autoimmune
Type B - bacterial
Type C - chemical

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15
Q

What is gastritis

A

Gastric mucosal lining inflammation

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16
Q

Type A (autoimmune) gastritis pathophysiology (4)

A

Autoantibodies attack parietal cells + intrinsic factor –> atrophy of parietal cells –> decreased acid secretion + loss of intrinsic factor –> vit B12 deficiency

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17
Q

Type A gastritis risk factors (2)

A

Existing autoimmune diseases

Critically ill

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18
Q

Gastritis symptoms (4)

A

Dyspepsia - epigastric pain
Nausea
Vomiting
Loss of appetite

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19
Q

Type A gastritis investigations (6)

  • 2 investigations to rule out H. pylori
  • imaging
  • bloods (for a certain vitamin and 2 autoantibodies)
A

Urea breath test - to exclude H. pylori
H pylori faecal antigen test - to exclude H. pylori

Endoscopy + biopsy

Serum vitamin B12
Parietal cell autoantibodies
Intrinsic factor autoantibodies

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20
Q

Type A gastritis treatment (3)

A

CORRECT VITAMIN DEFICIENCY
-Vit B12 injection

Hydrogen receptor blocker - ranitidine
PPI - omeprazole

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21
Q

Type B gastritis cause

A

H pylori infection

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22
Q

Type B (bacterial) gastritis pathophysiology

A

H pylori causes inflammation of gastric mucosa –> increased mucosal permeability

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23
Q

Difference between H. pylori infection in upper stomach and lower stomach
(describe if the acid secretion is increased or decreased and what disease it is more likely to progress on to)

A

If H. pylori infects upper stomach –> gastritis of body –> DECREASED ACID PRODUCTION –> gastric cancer

If H. pylori infects lower stomach –> antral gastritis –> INCREASED ACID PRODUCTION –> duodenal disease

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24
Q

Type B gastritis/H. pylori investigations (4)

  • tests to confirm H. pylori
  • imaging + histological diagnosis
A

Urea breath test - to confirm H. pylori

H. pylori faecal antigen test - to confirm H. pylori

Endoscopy + biopsy

Serology - IgG against H. pylori

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25
Type B gastritis treatment (H.pylori eradication therapy)
Eradication therapy for 14 days (2 antibiotics + 1 PPI): - Clarithromycin - Amoxycillin (or metronidazole if penicillin allergic) - Omeprazole
26
Type C gastritis risk factors (3)
Long term use of - NSAIDs - alcohol Chronic bile reflux
27
Type C (chemical) gastritis pathophysiology
Caused by Drugs (NSAIDs), alcohol, bile reflux NSAIDs reduce prostaglandin production (which protects stomach) --> inflammation
28
Type C gastritis investigations (4) - 2 investigations to rule out H. pylori - imaging - bloods
Urea breath test - to rule out H .pylori H pylori faecal antigen test - to rule out H .pylori Endoscopy + biopsy FBC
29
Type C gastritis treatment
Stop NSAIDs/alcohol Hydrogen receptor blockers - ranitidine PPI - omeprazole
30
Complications of gastritis
Chronic gastritis Peptic ulcer disease Vitamin B deficiency Achlorhydria - decreased/absent gastric acid production
31
What is gastric outlet obstruction
Obstruction of pylorus --> DELAYED gastric emptying
32
Gastric outlet obstruction causes (3)
Fibrotic stricture from healing of gastric ulcer Tumour - gastric cancer, pancreatic cancer (in the head) Pyloric stenosis
33
Gastric outlet obstruction symptoms (3) and signs (2)
Symptoms: Postprandial nausea/vomiting --> alkalosis Epigastric pain Early satiety Signs: Abdominal distension/bloating Weight loss
34
Gastric outlet obstruction investigations - bloods (2) - imaging (3)
U+Es - low K+ due to prolonged vomiting RFTs (impaired) - creatine may be high due to abnormal renal function, low albumin UGIE - to see any mechanical obstruction, i.e. pyloric stenosis or tumour Abdo XR - to see if there's any SI obstruction Gastric emptying scintigraphy - assesses for how much food is retained in stomach after 4 hours; would indicate GASTROPARESIS
35
Gastric outlet obstruction treatment - medical (2) - surgical (2)
Pro-kinetics - promote GI motility so faster gastric emptying Anti-emetics Endoscopic balloon dilation - if stricture present from a healed ulcer or pyloric stenosis Surgery - antrectomy/gastrectomy/gastrojejunostomy if serious
36
Gastric cancer is usually what type of tumour
Adenocarcinoma
37
Gastric cancer pathophysiology (3)
From chronic gastritis, cancer can develop through phases of intestinal metaplasia --> intestinal dysplasia --> carcinoma Loss of tumour suppressor genes (e.g. p53)/ Overexpression of oncogenes
38
Gastric cancer risk factors (5)
Chronic H pylori infection Pernicious anaemia - from B12 deficiency High nitrate diet Smoking Family history of gastric cancer
39
Gastric cancer symptoms (3) and signs (4) | -usually asymptomatic until ADVANCED
Symptoms: Dyspepsia - epigastric pain Nausea/vomiting Dysphagia - not as common; more so if proximal tumour ``` Signs: Weight loss/anorexia Acute bleeding -haematamesis -melaena Chronic bleeding -Iron deficiency anaemia ```
40
Gastric cancer diagnostic investigation + staging investigations (4)
UGIE + BIOPSY Staging - EUS, - CXR, - CT chest/abdo/pelvis, - PET CT (more sensitive than plain CT for metastases)
41
Gastric cancer treatment - curative (1) - non-surgical candidate (1) - palliative for advanced/metastatic
Gastrectomy +/- perioperative/postoperative chemotherapy (given depending on stage of cancer at diagnosis) Non-surgical - chemoradiotherapy Chemoradiotherapy
42
Complications of gastric cancer (4)
Malnutrition Gastric obstruction - may obstruct pylorus GI bleed Gastric perforation - tumour can erode through wall --> peritonitis
43
4 ways that gastric cancer can spread
Direct Lymphatic Blood Transcoelomic (spreads into peritoneal cavity)
44
5 places gastric cancer spreads to
Lymph nodes Liver Peritoneum Lungs Bone marrow
45
Prognosis of gastric cancer
5 year survival rate less than 20%
46
Differentials of haematemesis (5)
Peptic Ulcer Gastric/oesophageal carcinoma Oesophageal varices Mallory Weiss Tear
47
Benign disorders of the oesophagus (3)
GORD Peptic ulceration (can get this in lower oesophagus) Barrett's oesophagus
48
Does H. pylori increase or decrease gastric acid secretion in patients with - duodenal ulcers - gastric cancer
DU - increases acid secretion Gastric cancer - decreases acid secretion
49
Organic v functional dyspepsia
Organic - definitive pathological cause Functional - abnormal function but normal structure
50
If ALARM features indicate dyspepsia, what investigation should be done
UGIE
51
Describe the characteristics of H.pylori (4)
Gram negative, spiral shaped, microaerophilic, flagellated
52
H. pylori only resides where
Gastric surface MUCOSA layer, doesn't penetrate epithelium below
53
What characteristics of H.pylori allows it to escape from the toxic gastric acid around it (2)
Its tail (flagellated) allows it to burrow into the mucous layer (but doesn’t burrow through epithelium) It produces urease which creates a halo of alkalinity around the bacteria
54
H. pylori typically has to to chronically infect what part of the stomach to cause gastric cancer
Body
55
H. pylori typically has to to chronically infect what part of the stomach to cause duodenal disease
Antrum
56
How does the urea breath test detect H.pylori
swallow urea labelled with radioactive carbon If isotope-labelled CO2 detected in exhaled breath then indicates that the urea swallowed was split by urease (produced by H pylori) into ammonia and CO2 (UREASE DEPENDENT TEST)
57
What enzyme does H.pylori produce
Urease
58
Invasive investigations of H.pylori (non invasive = serology, urea breath test, faecal H.pylori antigen test) (2)
Gastric biopsy Rapid slide urease test - gastric biopsy placed onto gel, the urease produced by H pylori (if present) will break down the yellow gel and turn it pink (UREASE DEPENDENT TEST
59
What is a fundoplication + what is it done for
Wrapping fundus of stomach around lower oesophagus to create a valve around the LOS to tighten it --> reduces reflux Done for severe GORD
60
Name a common approach used in total gastrectomy
Roux en Y
61
Treatment of acute bleeding peptic ulcer (4)
Endoscopic therapy - injecting adrenaline - constricts ulcer area - cautery to burn/scar bleeding vessel - endoclip PPI
62
Duodenal ulcers are relieved after what
Meals Gastric ulcers tend to WORSEN after meals
63
If peptic ulcer has perforated and caused bleeding, what are the 2 signs of the bleeding
Overt bleeding (visible) - Haematemesis - coffee ground vomit - Melaena - dark foul smelling stool Occult bleeding -stool haem test +ve
64
What is gastroparesis (similar to gastric outlet obstruction but not exactly the same)
NON-MECHANICAL OBSTRUCTION of pylorus (i.e. not due to a physical abnormality like pyloric stenosis or a tumour or ulcer) --> DELAYED gastric emptying
65
Paraneoplastic complication/manifestation of gastric cancer on the skin
SEBORRHOEIC KERATOSES ('stuck on' lesions)

GI Anatomy (21 decks)

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