Gastric Disorders Flashcards Preview

S2.1 Gastrointestinal > Gastric Disorders > Flashcards

Flashcards in Gastric Disorders Deck (23)
Loading flashcards...
1
Q

What is dyspepsia?

A
Pain or discomfort in upper abdomen - retrosternal pain, nausea, vomiting, bloating, fullness, early satiety and heartburn
Very common (80%) of people have no serious underlying pathology
2
Q

What are various causes of dyspepsia?

A

Peptic Ulcer
Gastritis
Non-ulcer Dyspepsia (basically Idiopathic Dyspepsia)
Gastric Cancer
IBS
Colonic Cancer
Coeliac Disease
Gallstones
Pancreatic disease
Liver disease/disorders
Drugs
Systemic Disease

3
Q

What is gastritis and what are the different types?

A

Inflammation in gastric mucosa
A - Autoimmune (parietal cells)
B - Bacterial (H Pylori)
C - Chemical (Bile/NSAIDs)

4
Q

What are some causes of nausea/vomiting?

A

Immediately after eating - psychogenic

1 hour+
- Pyloric obstruction or motility disorders (diabetes, post gastrectomy)

12+
- obstruction etc.

Causes

  • drugs
  • pregnancy
  • migraine
  • cyclical vomiting syndrome
  • alcohol
5
Q

What are the ALARM symptoms?

A

A - Anorexia
L - Loss of Weight
A - Anaemia (Fe deficiency)
R - Recent onset >55 years or persistent
M - malaena/haematemesis or Mass

Also, swallowing problems/dysphagia

6
Q

What investigations might be done in dysphagia?

A

History/Examination are key
- drug history

Bloods - FBC, Ferritin, LFTs, U&Es, Calcium, Coeliac serology/serum IgA

Upper GI endoscopy if ALARM or >55
- refer to GI if persistent despite Pylori therapy

7
Q

What drugs typically may cause dysphagia?

A

NSAIDs
Steroids
Bisphosphonates
Calcium antagonists
Nitrates
Theophylline

8
Q

How is H Pylori diagnosed?

A

Non-invasive

  • serology (IgG against pylori)
  • 13C/14C urea breath test
  • stool antigen test - ELISA - (needs PPI cessation for 2w)

Invasive
- endoscopy
> histology (gastric biopsies stained for bacteria)
> culture of biopsy
> rapid slide urease test (CLO)

Treat symptomatically if all negative

9
Q

What are some differential diagnoses of dysphagia?

A

Dyspepsia alone
Gastritis
Peptic Ulcer
Gastric Outlet Obstruction
Gastric Cancer

10
Q

Helicobacter Pylori details?

A

Gram -ve
Spiral shaped
Microaerophilic
Flagellated

Can only colonise gastric type mucosa
Does not penetrate epithelial layer
Evokes immune response in underlying mucosa, host genetics dependent

11
Q

H Pylori Outcomes?

A

Asmyptomatic
Chronic Gastritis
Chronic atrophic gastritis
Intestinal metaplasia
Ulcer (Gastric, Duodenal)
Gastric Cancer
MALT Lymphoma

12
Q

Risk factors/causes for Peptic Ulcer?

A

H Pylori
NSAIDs
Smoking

Rarely

  • Zollinger-Ellison Syndrome
  • Hyperparathyroidism
  • Crohn’s
13
Q

Symptoms/signs of peptic ulcer?

A

Epigastric pain/tenderness
Nausea/vomiting
Weight loss/Anorexia
Haematemesis/malaena
Nocturnal/hunger pain (more common in DU)
Back pain (suggests penetration of posterior DU)

14
Q

Treatment of peptic ulcer?

A

PPI or H2 receptor antagonist (ranitidine)
Stop NSAIDs or ensure protective agents

Surgery only in complicated DU

H Pylori treatment (triple therapy 7 days)

  • clarithromycin
  • amoxicillin/metronidazole/tetracycline
  • PPI
15
Q

Possible complications of peptic ulcer?

A

Acute bleeding (haematemesis/malaena)
Chronic bleeding (Anaemia)
Perforation
Fibrotic stricture
Gastric outlet obstruction

16
Q

Symptoms/signs of gastric outlet obstruction

A

Vomiting - lacks bile, fermented foodstuffs
Early satiety, abdominal distention, weight loss, gastric splash
Dehydration
Metabolic alkalosis
Low Cl, Na, K in bloods, renal impairment

17
Q

Diagnosis and treatment of gastric outlet obstruction?

A

Upper GI endoscopy

Identify cause - stricture, ulcer, cancer
Treated with endoscopic balloon dilatation, surgery

18
Q

What are the different types of bariatric surgery?

A

Restrictive
Malabsorptive
Combination

19
Q

What are some examples of bariatric surgery?

A

Laparoscopic adjustable gastric banding
Laparoscopic gastric bypass
Laparoscopic sleeve gastrectomy

20
Q

Pros/cons of adjustable gastric band?

A

+
Minor surgery
Reversible/adjustable
Low risk of complications
Mortality 0.1%

-
Requires implanted device
Easy to ‘cheat’
Risk of prolapse/slippage
15% require revisional surgery

21
Q

Pros/cons of Gastric Bypass

A

+
Quick and dramatic weight loss
Pedigree
Dumping syndrome

-
More invasive
Malabsorptive component requires lifelong supplements
More complex if requires revision
Mortality 0.5%

22
Q

Sleeve gastrectomy pros/cons

A

+
Good medium term outcomes
No dumping syndrome
No small bowel manipulation
No foreign body

-
More invasive
Long staple line (bleeding/leak risk)
Short pedigree
Mortality 0.4%

23
Q

Complications of bariatric surgery?

A

Anastomotic leak
DVT/PE
Infection

Malnutrition
Vitamin/mineral deficiencies

Hair loss
Excess skin