Gastric Disease

Question 1

What are common gastric disorders?

Answer 1

GORD
Gastritis
Peptic ulcer disease
Zollinger-Ellison disease

Question 2

What is GORD?

Answer 2

Gastro-oesophageal reflux disease

Question 3

What are symptoms of GORD?

Answer 3

Chest pain
Acid taste in mouth
Cough

Question 4

What are potential consequences of GORD?

Answer 4

Oesophagitis
Strictures
Barrett’s oesophagus

Question 5

What is Barrett’s oesophagus?

Answer 5

Metaplasia from squamous to gastric epithelium

Question 6

What makes up the lower oesophageal sphincter?

Answer 6

Muscular element
Right crus of diaphragm
Acute angle of entry of oesophagus to stomach
Intra-abdominal pressure - collapses end of oesophagus slightly

Question 7

What causes GORD?

Answer 7

Relaxtion of LOS

Increased intra-abdominal pressure

Question 8

How can GORD be managed?

Answer 8

Lifestyle modifications
- weight loss

Antacids
H2 antagonists
PPIs

Question 9

What is a hiatus hernia?

Answer 9

Herniation of stomach through diaphragm

Question 10

What is gastritis?

Answer 10

Inflammation of the stomach

Question 11

What are the symptom of gastritis?

Answer 11

Pain
Nausea
Vomiting
Bleeding

Question 12

What are the causes of acute gastritis?

Answer 12

NSAID use
Alcohol
Chemotherapy
Bile reflux

Question 13

What is acute gastritis?

Answer 13

Acute damage to mucosa normally related to chemicals

Question 14

How does NSAID use cause acute gastritis?

Answer 14

Reduces prostaglandins
Reduces mucosa blood flow
Less repair

Question 15

How does alcohol cause acute gastritis?

Answer 15

Damages protective mucus layer

Question 16

How does chemotherapy cause acute gastritis?

Answer 16

Prevents rapid cell turnover

Question 17

How does bile reflux cause acute gastritis?

Answer 17

Bile reacts with stomach lining

Question 18

How is acute gastritis managed?

Answer 18

Remove irritant

Question 19

What are the causes of chronic gastritis?

Answer 19

Bacterial
- H.pylori

Autoimmune
- antibodies to parietal cells

Question 20

What are the symptoms of autoimmune chronic gastritis?

Answer 20

Anaemia symptoms
Glossitis
Anorexia
Neurological symptoms

Question 21

What are helicobacter pylori?

Answer 21

Gram negative, helix shaped, flagellated bacteria

Question 22

How is H. pylori spread?

Answer 22

Oral - oral

Faecal - oral

Question 23

How does H.pylori cause damage?

Answer 23

Produces urease

• converts urea to ammonium
• increase local pH

Release cytotoxins
- direct epithelial injury

Question 24

What happens if H.pylori colonises in antrum?

Answer 24

Increased gastrin secretion

• increased parietal cell acid secretion
• duodenal epithelial metaplasia
• duodenal ulceration

Question 25

What happens if H.pylori colonises in the body?

Answer 25

Atrophic effect | - gastric ulcer

Question 26

How is H.pylori diagnosed?

Answer 26

Urea breath test - carbon 13 Stool antigen test Blood test

Question 27

How is H.pylori managed?

Answer 27

PPI | Amoxicillin

Question 28

What is peptic ulcer disease?

Answer 28

Defects in gastric/duodenal mucosa | - must extend through muscularis mucosa

Question 29

Where are common sites of peptic ulcers?

Answer 29

1st part duodenum Lesser curve stomach Antrum stomach

Question 30

What is the pathophysiology of peptic ulcers?

Answer 30

Breakdown of normal stomach defences

Question 31

What causes peptic ulcers?

Answer 31

``` Stomach acid H.pylori NSAIDs Smoking Stress ```

Question 32

What are acute peptic ulcers?

Answer 32

Ulcers that develop as part of acute gastritis

Question 33

What are chronic peptic ulcers?

Answer 33

Ulcers commonly occurring at mucosal junctions

Question 34

What is the morphology of peptic ulcers?

Answer 34

<2cm | Base = necrotic/granulation tissue

Question 35

What are clinical consequences of peptic ulcers?

Answer 35

Scar tissue shrinkage - narrow stomach lumen/cause pyloric stenosis Perforation = peritonitis Erosion into vessel

Question 36

What are the symptoms of peptic ulcer disease?

Answer 36

Epigastric pain - burning - following meals Bleeding - melaena - haematemesis Weight loss

Question 37

How can peptic ulcer disease be managed?

Answer 37

Lifestyle modification Test for H.pylori PPIs Endoscopy

Question 38

What is Zollinger-Ellison syndrome?

Answer 38

Non beta islet cell gastrin secreting tumour of the pancreas

Question 39

What is the effect of Zollinger-Ellison syndrome?

Answer 39

Proliferation of parietal cells - increased acid secretion - severe ulceration