Gastric Disease Flashcards
(43 cards)
1
Q
Describe the prevalence and incidence of gastric disease
A
- up to 40% of adults suffer from dyspepsia (indigestion) a year
2
Q
State the NICE definition of Dyspepsia
What are 5 symptoms included?
A
- Upper GI tract symptoms, typically for 4 or more weeks
- Abdominal pain
- Discomfort
- Heartburn
- Acid reflux
- Nausea and/ or vomiting
3
Q
List 3 common gastric disorders
What are 2 causes of Chronic Gastritis (Can also be acute)
A
- Gastritis
- GORD
- Peptic Ulcer Disease
- Bacteria
- Autoimmune
4
Q
List 4 symptoms of GORD
A
- Chest pain
- Acid taste in mouth
- Cough
- Asymptomatic
5
Q
What are 6 consequences of GORD
A
- Nothing
- Oesophagitis
- Ulceration
- Haemorrhage
- Fibrous Strictures-> Dysphagia
- Barrett’s Oesophagus (Strat. squamous-> Gastric columnar)
6
Q
Name 5 risk factors for GORD
A
- Ineffective LOS
- Anything that increases intrabdominal pressure
- Obesity
- Pregnancy
- Hiatal hernia (LOS moves into thorax)
- Delayed gastric emptying
7
Q
List 3 treatment mechanisms for GORD
A
- Lifestyle modifications (weight loss, smaller meals, less alcohol and caffeine, stop smoking, avoid trigger foods)
- Surgery (Rare) (Fundoplication where fundus is wrapped around LO to assist sphincter mechanism)
- Pharmacological (Antacids, H2 antagonists, Proton pump inhibitors )
8
Q
The LOS is normally contracted. When does it relax?
A
When swallowing food
9
Q
What are 3 components of the LOS
A
- Muscular elements (Intrinsic muscles + Part of diaphragm)
- Right crus of diaphragm (tightens around LOS)
- Acute angle of entry into stomach helps prevent reflux
10
Q
What cancer can Barrets Oesophagus lead to? (Due to increased risk of dysplasia)
A
Adenocarcinoma (Normally we get squamous cell carcinoma)
11
Q
What is Gastritis?
What is 1 way it can be diagnosed?
What are 4 typical symptoms?
A
Inflammation of stomach mucosa
Diagnosable by endoscopy
- Pain
- Nausea
- Vomit
- Haemorrhage
12
Q
The causes of Acute Gastritis can lead to Chronic Gastritis.
List 4 causes
A
- Heavy use of NSAIDs
- Lots of alcohol
- Chemotherapy
- Bile reflux-> Chemical injury -> Damaged epithelia and reduced mucus production
13
Q
List 3 symptoms and 1 treatment for Acute Gastritis
A
- Asymptomatic
- Abdominal pain, nausea, vomiting
- Occasional bleeding (which can be fatal)
- Removal of irritant
14
Q
What are 3 causes of Chronic Gastritis?
A
- Autoimmune (Antibodies against parietal cells)
- Infection with H. pylori (most common)
- Chemical/ reactive;
- Minimal inflammation
- Chronic alcohol abuse, NSAIDs, Bile reflux
15
Q
List 4 pathological changes in Acute and Chronic Gastritis
A
Acute;
- Epithelial damage
- Some epithelial hyperplasia
- Vasodilation
- Neutrophil response
Chronic;
- Lymphocyte response
- Glandular atrophy
- Fibrotic changes
- Metaplastic changes
16
Q
Describe Autoimmune Chronic Gastritis
A
- Antibodies target Parietal cells, which produce HCl and Intrinsic Factor
- Can lead to Pernicious Anaemia, as Vit B12 is not absorbed in Ileum
17
Q
List 4 symptoms of Autoimmune Chronic Gastritis
A
- Anaemia symptoms (Megaloblastic anaemia)
- Glossitis
- Anorexia (Due to loss of appetite)
- Neurological symptoms
18
Q
What are 2 groups of symptoms of H. pylori causing Chronic Gastritis?
A
- Asymptomatic/ similar to acute gastritis
- Peptic ulcers, Adenocarcinoma, MALT Lymphoma
19
Q
Describe H. pylori
How does it enter body?
A
- Helix shaped
- Gram negative
- Microaerophilic (Needs only a little bit of O2)
- Oral to oral OR Faecal to oral
20
Q
Where does H. pylori go once it enters the stomach?
How is it adapted to do so?
A
- Migrates and adheres to gastric epithelia
1. Flagella for motility
- Uses chemotaxis to find areas of lower acidity (Surface of
epithelia, under mucus layer) - Adhesins to attach to Gastric Epithelia and resist peristalsis
- Produces Urease, which converts Urea to Ammonium, raising pH around itself. (This prevents death by acid)
21
Q
What 5 problems are caused by presence of H. pylori?
A
- CagA gene causes cytotoxin release cytotoxins-> Direct epithelial injury + Inflammation + associated with cancer
- Produce ammonia-> Toxic to epithelia
- Promotes inflammation
- Produces VacA, which increases paracellular permeability and is toxic to epithelia
- Secretes Mucinases, Proteases, Lipases-> Mucus layer damage
22
Q
Describe what happens if H. pylori colonise predominantly in the Antrum
A
- Increased G cell/ decreased D cell activity-> More Gastrin made
- Parietal cells make more HCl and increase in number
- Chyme more acidic-> Duodenum damage and metaplasia (to be more like gastric epithelia)
- H. pylori colonise Duodenum-> Duodenal ulcers
23
Q
What if H. pylori colonise predominantly in Body of stomach?
A
- Atrophy of Parietal cells
- Gastric ulceration
- Increased risk of Dysplasia-> Cancer
24
Q
What happens if H. pylori colonise predominantly in both Antrum and Body of stomach?
A
Asymptomatic
25
How can we diagnose Chronic Gastritis secondary to H. pylori infection?
- Stool antigen test
- Urea Breath test (Using carbon 13)
- Upper GI Endoscopy to get biopsy
26
Describe the Urea Breath Test
Gastric Urea normally contains Carbon 12 mainly with only 1% Carbon 13
- In test, patient ingests Urea that is mainly Carbon 13
- If H. pylori present, this is broken down into NH4 and CO2
- If Carbon 13 detected in exhaled CO2, H. pylori are present
27
How do we treat Chronic Gastritis secondary to H. pylori infection?
Proton Pump Inhibitor + 2 Antibiotics (Clarithromycin/ Metronidazole/ Amoxicillin)
Side effects: Diarrhoea and nausea
Course can be extended from 7 to 14 days, but minimal additional effect
28
# Define Peptic Ulcer Disease
Where are they most common?
Where do they commonly occur if in the stomach?
Defect in Gastric/ Duodenal mucosa, that extends through Mucularis Mucosa
Most common in proximal duodenum
Commonly affect Lesser Curve and Antrum of stomach
29
Compare Gastric and Duodeneal ulcers in;
- Incidence
- Age
- Social class
- Blood group
- Acid levels
- H. pylori
Gastric;
- More common with increasing age
- More common in low social classes
- More common with Blood Grp A
- Normal/ low acid levels
- 70% caused by H. pylori
Duodenal;
- 3 times more common than gastric ulcers
- More common with age up to 35 years
- No correlation with social class
- More common with Blood Grp O
- Normal/ High levels (More incidence with higher levels)
- 100% caused by H. pylori
30
What proportion of Gastric and Duodenal ulcers are caused by H. pylori?
Describe how H. pylori colonisation in Antrum can cause Duodenal Ulcers
Gastric- 70%
Duodenal- 95 to 100%
- Increased G cell stimulation-> More gastrin-> More HCl released
- Increased acidity of chyme-> Duodenal damage
31
List 3 causes/ risk factors of Peptic Ulcer Disease
- Mucosal injury (H. pylori, NSAIDs)
- Smoking (causes relapse of ulcer)
- Massive Physiological Stress (E.g Burns)
32
Compare the incidence of Acute and Chronic Peptic Ulcer Disease
Acute- As a result of Acute Gastritis (heals eventually)
Chronic- Occurs at Mucosal Junctions
33
Describe 2 Mucosal junctions where Chronic Peptic Ulcer Disease may occur
- Where Antrum meets Body of stomach
| - In Duodenum where Antrum meets Small Intestine
34
Describe the Morphology of Peptic Ulcer Disease
- Generally<2cm, but can be up to 10cm
- Ulcer base is Necrotic or Granulation tissue
- When healing, Muscularis Propria/ Externa can be replaced by Scar Tissue
35
What can repeated healing of Chronic Peptic Ulcer Disease in stomach lead to?
- Scar tissue in Muscularis Externa can shrink-> Narrowing of stomach lumen or Pyloric Stenosis-> Vomiting
- Perforation of stomach/ duodenal wall-> Peritonitis
- Erosion/ Ulceration into adjacent structure (Liver or Pancreas)
- Haemorrhage from vessel in base of ulcer-> Malaena (Slow Upper GI bleed)
- Malignancy (Rare)
36
State how and explain why does Malaena present?
- Slow Upper GI bleed, blood moves through GI Tract
| - Haem component oxidised-> Tarry black stool
37
What is Haematemesis? How can it happen?
Vomiting of blood
Haemorrhage from large vessel at base of ulcer (E.g Gastro-duodenal artery behind Duodenum)
38
List 4 general symptoms of Peptic Ulcer Disease
- Epigastric pain (sometimes back pain)
- Burning/ gnawing pain
- Often after meals
- Often at night, especially Duodenal ulcers
39
List 3 serious symptoms of Peptic Ulcer Disease
- Haematemesis/ Malaena
- Early satiety from repeated scarring (stomach can’t expand as much)
- Weight loss (Reluctance to eat due to pain)
40
In the past, why was eating food thought to reduce pain initially in patients with Duodenal Ulcers?
- Food intake causes Pyloric Sphincter to close
- Less chyme/ irritation to Duodenal Ulcer
(However pain would return later once Sphincter relaxes and chyme enters duodenum)
41
List 5 ways Peptic Ulcer Disease can be managed
- Lifestyle modification
- Avoid exacerbating medications
- Test for H. pylori (Use PPIs and ABs to eradicate if present, this promotes Ulcer Healing)
- Endoscopy (if actively bleeding, repair if perforated)
42
What is Functional Dyspepsia?
When you have symptoms of ulcer disease, without any physical evidence of organic disease
43
Suggest 1 way we can non-invasively look for perforation
Chest X-ray
