Gastric Problems Flashcards
What is gastritis
Inflammation of the stomach lining
What causes gastritis [5]
Autoimmune
H.pylori
Chemical
Drugs - NSAIDs / cocaine, Alcohol
Bile reflux = inflammation
Stress - surgery / burns
Crohns
How does H.pylori cause gastritis [2]
H.pylori
- Secretes urease which splits urea into NH4 + HCO3
- HCO3 stimulates stomach acid to be produced
What are the S+S of gastritis [8]
Dyspepsia
Burning stomach pain (worse after eating and better nil by mouth)
N+V
Early satiety
Bleeding or ulcer formation if lining worn away, IDA if bleeding
Pernicious anaemia due to lack of intrinsic factor
NO WEIGHT LOSS
SYSTEMICALLY WELL
When does gastritis tend to lead to bleeding [2]
Impaired coagulation
Medication - anti platelet / coagulant
How do you Dx gastritis [5]
Stool test looking for infection / blood FBC - low Hb Urea breath test for H.pylori Endoscopy + biopsy - rapid urea test CLO Barium swallow
How do you treat gastritis [4]
Treat underlying cause
Antacids / milk will improve
PPI
H2 blocker - not always needed
What are the complications of gastritis [6]
Polyp Tumour Bleeding B12 deficiency in autoimmune Obstruction Perforation
How does urea breath test work [2]
Urea split by urease into HCO3+NH4
CO2 is detected
What is the autoimmune attack in gastritis that causes B12 deficiency [4]
Ab against parietal cells and intrinsic factor binding sites
Lose intrinsic factor = B12 deficient
Less acid production
Lymph infiltration + fibrosis
Which part of the GI system does peptic ulceration affect [3]
Indicate most common
Lower oesophagus
Body and Antrum
Duodenum - most common
Pathogenesis: peptic ulcers
Imbalance between acid secretion and mucosal barrier
What is associated with peptic ulcers [3]
H.pylori - stimulate acid production
Eradication will heal 90%
Increased acid = duodenal
Inflammatory response = gastric
NSAID - suppress prostaglandin synthesis leading to inflammation
Prescribe omeprazole if not CI with NSAID in elderly
Other drugs
Zollinger Ellison Syndrome
= Gastric secreting pancreatic tumour causes poor healing of duodenal ulcer
Associated MEN
Diarrhoea
What are the symptoms of peptic ulcers [6]
Epigastric / back pain Nocturnal hunger pain N+V, Haematemesis Weight loss, Anorexia Haematochezia - fresh, malaena No vomiting (differentiate from pancreatitis)
What are the RF for peptic ulceration [6]
What drugs are included under risk factors [4]
H.PYLORI Alcohol, Smoking Zollinger Ellison Syndrome Delayed gastric emptying Stress - surgery / burns Spicy food Crohn's but rare
Drugs:
NSAIDs, Steroid
SSRI
Biphosphonate
How do you diagnose peptic ulcer [4]
Stool test or urea breath test for H.pylori
Endoscopy
Barium swallow
Measure gastric conc when off PPI for Zollinger Ellison Syndrome
How do you investigate perforation [5]
Blood test CXR - small air (large if colonic) CT or laparoscopy Endoscopy = DAMAGE FURTHER SO DON'T Gastrograff (oral contrast study) to see if perforated ulcer has healed if no surgical Rx as will see dye
How do you treat peptic ulceration [5]
PPI if H. Pylori negative H.pylori eradication Stop NSAID Alternative pain relief Lifestyle modifications Surgery if perforation
How do you treat bleeding in peptic ulcers [6]
ABCDE Endoscopy, PPI after Inject adrenaline Clip Thermal contact Haemospray Angiography with embolisation
What are the complications of peptic ulcer [6]
Haemorrhage Perforation > peritonitis Gastric outlet obstruction Fibrosis, Pyloric stenosis Polyps Tumour
What is gastric outlet obstruction
Any disease that produces a mechanical impediment to gastric emptying
What causes gastric outlet obstruction [6]
Stricture Ulcer Cancer Polyps Pyloric stenosis (congenital) Hiatus hernia
Presentation pyloric stenosis [5]
Vomiting - no bile (clear fluid from saliva and gastric juice) > dehydration Early satiety, Weight loss Distention Gastric splash Renal impairment
How do you diagnose gastric outlet obstruction [2]
Upper GI endoscopy
Bloods - low Cl, Na, K, renal impairment > Metabolic alkalosis
