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GI - stomach Flashcards

(52 cards)

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1
Q

what is GORD

A

reflux of acid and bile from stomach due to reduced LOS tone
can also be caused by
=> reduced barrier function
=> increased visceral sensitivity in the oesophagus
=> poor oesophageal clearence

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2
Q

what can prolonged reflux lead to

A 
oesophagi's
benign oesophageal strictures
barrett's oesophagus
haemorrhage
adenocarcinoma
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3
Q

typical s/s GORD

A 
heart burn
chest pain
water brash
dysphagia
odynophagia
acid reflux
weight loss
damage to enamel
adult onset asthma and cough
laryngitis
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4
Q

what are some risk factors of GORD

A 
alcohol
tobacco
obesity 
caffeine
hiatus hernia
age, family history
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5
Q

main investigate for GORD

A

endoscopy

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6
Q

what are some lifestyle treatments of GORD

A

lose weight / stop smoking / avoid alcohol/fatty foods/chocolate/peppermint
small regular meals

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7
Q

what are some drug treatments of GORD

A

antacids (symptomatic)

PPIs (symptomatic and healing)

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8
Q

when is surgery indicated in GORD and what does it aim to do

A

when PPIs ineffective

aims to increase resting lower oesophageal sphincter pressure

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9
Q

what is gastroparesis

A

delayed gastric emptying (not due to obstruction)

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10
Q

typical s/s of gastroparesis

A

fullness/bloating
nausea and vomiting
weight loss
upper abdo pain

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11
Q

what are some causes of gastroparesis

A

diabetes
weed
opiates
systemic diseases e.g. systemic sclerosis

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12
Q

what are the treatments of gastroparesis

A 
remove cause
liquid / low fat diet
small meals
promotability agents e.g. domperidone, metoclopramide
Gastric pacemaker
nutritional support
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13
Q

what are some causes of acute gastritis

A 
chemical insult
severe burn
NSAIDs
Heavy alcohol consumption
chemotherapy
head injury - increased ICP - increased stimulation of vagus nerve - increased acid production
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14
Q

gastritis is acidic damage to stomach mucosa due to imbalance in what

A

mucosal defence and acidic environment

—> superficial inflammatory erosion/peptic ulcer

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15
Q

s/s gastritis

A 
epigastric pain
bloating
fullness
heart burn
tenderness
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16
Q

ALARMS s/s gastritis

A 
A - anaemia
L - loss of weight
A - anorexia
R - recent onset/progressive
M - melenia/haematemesis
S - swallowing difficulty
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17
Q

what is chronic gastritis

A

chronic inflammation of the stomach mucosa

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18
Q

what are 2 causes of chronic gastritis

A

autoimmune

H. Pylori

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19
Q

what is the pathophysiology of autoimmune gastritis

A

autoimmune antibodies against parietal cells and intrinsic factor located in stomach body and fundus

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20
Q

what is autoimmune gastritis mediated by

A

T cells

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21
Q

what type of hypersensitivity is autoimmune gastritis

Study These Flashcards
A

type IV hypersensitivity

22
Q

what is a common complication of autoimmune gastritis

Study These Flashcards
A

pernicious anaemia - loss of intrinsic factor

23
Q

what are some s/s of pernicious anaemia

Study These Flashcards
A 
lethargy/weakness
dyspnoea
sore tongue
mild jaundice
diarrhoea
24
Q

how can pernicious anaemia be treated

Study These Flashcards
A

3 monthly injections of VB12

folic acid supplements

25
what can autoimmune gastritis predispose to
gastric carcinoma
26
where does H. Pylori reside
between epithelial cell surface and mucosal barrier | most commonly in antrum
27
H. Pylori is ...
gram negative bacilli (comma shaped rods) oxidase and catalase positive
28
what is the effect of H. Pylori
increase in secretion of gastrin from G cells which increases HCl secretion ---> peptic ulcers
29
H. Pylori increases the risk of ....
ulceration gastric adenocarcinoma MALT lymphoma
30
what is the test for H. Pylori
(13C) urea breath test (urease breath test) or stool antigen test or serology
31
if someone comes in with the symptoms of gastritis that is under 55 what should be tone
test for H. Pylori
32
if someone comes in with symptoms of gastritis that is over 55 / has ALARMS s/s what should be done or treated for H. Pylori and symptoms don't improve
Upper GI endoscopy / gastroscopy
33
what is the treatment for H. Pylori
PPI + 1g Amoxicillin BD + Clarithromycin 500mg BD penicillin allergic --> PPI + 400mg Metronidazole BD + clarithromycin 250mg BD
34
how long should H. Pylori treatment be stopped before retest
2 weeks
35
what are the 2 most common sites of peptic ulcers
``` proximal duodenum (90%) distal stomach (10%) ```
36
epigastric pain that improves with meals, is felt usually 2-3 hours after a meal and often wakes patients at night is most likely a ....
duodenal ulcer
37
what is the most common cause of duodenal ulcer
H. Pylori
38
Epigastric pain that is felt shortly after meals and may radiate to back is most likely a ....
gastric ulcer
39
what are some causes of gastric ulcers
``` H. Pylori NSAIDs reflux of duodenal bile content delayed epigastric emptying increased acid secretion/failure of mucosal defence ```
40
where in the stomach are gastric ulcers usually found
lesser curvature
41
what is the treatment for peptic ulcers
PPI (lansoprazole) H2RAs (ranitidine) Antacid (Gaviscon)
42
how are peptic ulcers diagnosed
test for H. Pylori upper GI endoscopy - stop PPI for 2 weeks
43
what are some complications of peptic ulcers
``` bleeding --> anaemia perforation malignancy (rare) gastric outflow obstruction fibrosis --> stenosis intractable pain ```
44
what is seen in the microscopy of peptic ulcers
``` clear cut edges, punched out layered: floor - necrotic fibrinopurulent debris base - inflamed granulation tissue deepest layer - fibrotic scar tissue ```
45
what would large and irregular edges indicate
cancer
46
what are peptic ulcers
breach of GI mucosa
47
what is the rome III criteria of functional dyspepsia
atleast one of following for 3 months with symptom onset 6 months prior to diagnosis - epigastric pain or burning - post prandial fullness - early satiety + no evidence of structural disease
48
what is the most common cause of functional dyspepsia
IBS/GORD overlap
49
what are some organic causes of dyspepsia
H. Pylori NSAIDs/COX2 gastric cancer peptic ulcers - most common
50
what is the treatment/diagnosis of dyspepsia
in absence of RFs check for H. Pylori | if HP negative --> acid inhibition
51
when should PPIs be taken
30 mins before a meal so they can begin function by the time meal is consumed
52
A person comes to GP with epigastric tenderness/burning, a palpable mass in the epigastric region and postprandial fullness. what could it be?
Dyspepsia

year 1 (45 decks)

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