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Gastric Pathology Flashcards

(43 cards)

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1
Q

What is a peptic ulcer?

A

Imbalance between acid secretion and mucosal barrier, creating sores/break in mucosal membrane of stomach or duodenum

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2
Q

What is the most common ulcer in the GI tract?

A

Duodenal ulcers

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3
Q

What is the most common cause of GI bleed?

A

Gastric ulcer

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4
Q

What sex are gastric ulcers most common in?

A

M>F

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5
Q

What age group are gastric ulcers most common?

A

Elderly

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6
Q

What causes gastric ulcers?

A

Helicobacter Pylori infection

Drugs

Zollinger-Ellison

Alcohol and smoking

Stress ulcers

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7
Q

What drugs can cause gastric ulcers?

A

NSAIDS

SSRI

Corticosteroids

Bisphosphonates

Causes multiple ulcers

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8
Q

What is Zollinger-Ellison?

A

Excessive levels of gastrin, usually due to gastrin secreting tumour of the duodenum or pancreas (MEN1)

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9
Q

How do gastric ulcers present?

A

Epigastric pain and tenderness

  • Worse at night and when eating
  • Radiation to back suggests perforation

N&V

Haematemesis/coffee ground vomit, if haemorrhage

Bloating, increased while eating meal

Iron deficiency anaemia, if haemorrhage

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10
Q

Compare peptic and duodenal ulcer symptoms

A

Epigastric pain worsens at night and when eating for peptic ulcers

Epigastric pain worsens when hungry for duodenal ulcers/improves when eating

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11
Q

What investigations are used in gastric ulcer diagnosis?

A

Upper GI Endoscopy, with CLO test to assess H pylor and biopsy to exclude malignancy

Other H Pylori investigation

  • Urea breath test
  • Stool antigen test
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12
Q

Descibe the urea breath test

A

Breath in urea and if there is O2 detection, it shows that urea was split into CO2 and ammonia

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13
Q

How are gastric ulcers managed?

A

Stop offending drugs

If H.Pylori positive, eradication therapy

If H.Pylori negative, PPI until ulcer is healed

Endoscopy can be used for ulcer monitoring

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14
Q

Name complications of gastric ulcers

A

Gastric carcinoma

Haemorrhage

Perforation, resulting in peritonitis

Scarring and strictures, leading to narrowing of the pylorus, leading to GORD and gastric outlet obstruction

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15
Q

How are perforated ulcers managed?

A

IV fluids

Analgesia

CXR shows pneuomperitoneum

Laparotomy

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16
Q

What are the types of peritonitis?

A

Localised, caused by underlying organ inflammation

Generalised, caused by perforation

Spontaneous bacterial peritonitis, associated with ascites

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17
Q

How does peritonitis present?

A

Guarding

Rebound tenderness

Percussion tenderness

Coughing tenderness

Rigidity

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18
Q

What are the ALARMS symptoms?

Study These Flashcards
A

Age over 55

Loss of weight

Anaemia

Recent onset of progressive symptoms

Masses and melaena/haematemesis

Swallowing difficulty

19
Q

What is the prognosis of gastric cancer?

Study These Flashcards
A

Poor, 5 year survival is 15%

20
Q

What are the causes of gastric cancer?

Study These Flashcards
A

Helicobacter Pylori Infection

Smoking

Diet

  • High salt and nitrate

FH

Previous gastric surgery

Blood group A

21
Q

How does gastric cancer present?

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A

Dyspepsia/Epigastric pain

Weight loss

N&V

Melaena

Upper abdominal mass

Virchow’s lymph node

Dysphagia

Cachexia

22
Q

What are the classic metastatic signs of gastric cancer?

Study These Flashcards
A

Hepatomegaly

Palpable Virchow’s node, located in the left supraclavicular fossa

23
Q

What investigations are used in gastric cancer diagnosis?

Study These Flashcards
A

FBC

  • Iorn deficiency anaemia

Endoscopy with multiple biopsies

Barium/contrast meal

Staging imaging/CT

24
Q

What biopsy sign is seen in gastric adenocarcinoma?

Study These Flashcards
A

Signet ring cells, the higher the number the worse the prognosis

25
How is gastric cancer managed?
Gastrectomy plus lymph node resection Palliative * Chemotherapy * Procedures centred on relieving gastric obstruction
26
Name complications of a gastrectomy
B12 deficiency/subacute combined degeneration of the spinal cord Iron deficiency anaemia Dumping syndrome Vitamin D deficiency Osteoporosis Weight loss Increased gall stone risk Increased gastric cancer risk
27
What type of bacteria is H.Pylori?
Gram negative
28
What enzyme does H.Pylori release and why is this clinically relevant?
Releases the enzyme urease which breaks down urea into ammonia and CO2, creating an alkaline shield Urea breath test shows it has been split
29
Describe the antibiotic therapy for H.Pylori
**CAP 7** Triple therapy for 7 days Clarithromycin Amoxicillin (PPI)
30
What causes gastritis?
Autoimmune Helicobacter Pylori infection Chemical
31
What are the chemical causes of gastritis?
Alcohol NSAIDS Duodenal reflux Aspirin
32
Name the complications of gastritis
Haemorrhage Stomach ulcers Stomach carcinoma Pernicious anaemia
33
When should a urea breath test not be done?
Should not be done within 4 weeks of treatment with an antibacterial or within 2 weeks of a PPI
34
What investigation is used to check for H.Pylori eradication and when is this done?
Urea breath test 8 weeks after eradication therapy
35
What condition is H.pylori most associated with?
Duodenal ulcers
36
Give side effects of PPIs
Hyponatraemia Hypomagnasaemia Osteoporosis Microscopic colitis Clostridium difficile infection
37
What patients should be offered an urgent endoscopy?
Any patient with dysphagia Upper abdominal mass consitent with stomach cancer Patients aged over 55 with weight loss and any of the following * Upper abdominal pain * Reflux * Dyspepsia
38
What patients should be offered a non-urgent/routine endoscopy?
Patients with haematemesis Patients over 55 who have * Treatment resistant dyspepsia * Upper abdominal pain with low haemoglobin levels * Raised platelet count with N&V, dyspepsia, reflux, weight loss etc
39
What is MALT lymphoma?
Lymphoma involving the mucosa-associated lymphoid tissue (MALT), frequently of the antrum of the stomach, but virtually any mucosal site can be affected
40
What is associated with MALT lymphoma?
H pylori infection
41
What is the prognosis of MALT lymphoma?
Good prognosis
42
How are gastric MALT lymphomas managed?
If low grade, 80% respond to H pylori eradication therapy In high grade or atypical cases, chemo and/or radiotherapy may be required
43
What artery is associated with perforated gastric ulcers?
Gastroduodenal

Gastrointestinal (14 decks)

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