H. Pylori and Gastric Disease Flashcards Preview

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Flashcards in H. Pylori and Gastric Disease Deck (29):
1

What is dyspepsia?

Indigestion/heartburn

2

What percentage of people presenting with dyspepsia will have no serious underlying disease?

80%

3

Give 5 typical presentations of common upper GI disorders

Dyspepsia
Retrosternal pain
Anorexia
Nausea
Vomiting
Bloating
Fullness
Early satiety
Abdominal pain

4

When should a referral for endoscopy be done in someone presenting with dyspepsia?

When there are alarms symptoms present

5

What are the alarms symptoms?

A - anorexia
L - loss of weight
A - anaemia, iron deficiency
R - recent onset, > 55 years of age or persistent despite treatment
M - melaena/haematemesis or abdominal mass
S - swallowing problems i.e. dysphagia

6

If a patient younger than 55 presents with dyspepsia, what should be done before an endoscopy/invasive investigation?

Test for H. pylori

7

What is gastritis?

Inflammation of the gastric mucosa

8

What are the three possible causes of gastritis?

Autoimmune
Bacterial
Chemical

9

What are the majority of peptic ulcers caused by?

H. pylori

10

What are two chemical causes of peptic ulcers?

Smoking
NSAIDs

11

Give three conditions which, rarely, can be responsible for peptic ulcers

Zollinger-Ellison syndrome
Hyperparathyroidism
Crohn's disease

12

Give 5 clinical features of peptic/duodenal ulcers?

Epigastric pain
Nocturnal/hunger pain
Back pain
Nausea and vomiting
Weight loss and anorexia
Epigastric tenderness
Haematemesis/melaena/anaemia

13

What might cause haematemesis, melaena or anaemia in a patient with a peptic or duodenal ulcer?

Haemorrhage of the ulcer

14

What are the possible treatments of peptic/duodenal ulcers?

Eradication therapy if caused by H. pylori
Antacid medication - PPIs or H2R antagonists
Stop NSAIDs if possible or give protective agents
Treat any arising complications
Surgery in complicated peptic ulcer disease

15

What are the possible complications of peptic/duodenal ulcers?

Acute bleeding
Chronic bleeding
Perforation
Fibrotic stricture
Gastric outlet obstruction

16

What are the clinical features of a gastric outlet obstruction?

Vomiting
Early satiety
Abdominal distension
Weight loss
Gastric splash
Dehydration and loss of H and Cl ions due to vomiting
Metabolic alkalosis
Low Cl, Na, K and renal impairment

17

What is the treatment of a gastric outlet obstruction?

Endoscopic dilation or surgery

18

How is a H. pylori infection eradicated?

Triple therapy for 7 days
Clarithromycin - 500mg bd
Amoxycillin - 1g bd
PPI e.g. omeprazole - 20mg bd

If penicillin allergic:
Metronidazole - 400mg bd or tetracyclin

19

What risk factors are associated with gastric cancer?

Smoking
High salt diet, food high in nitrates
H. pylori infection

20

What is the main histological type of gastric cancer?

Adenocarcinoma

21

What is the management of gastric cancer?

UGIE and biopsies
Staging investigations - CT chest/abdo
Surgical treatment and chemo
Palliative care

22

What kind of organism is helicobacter pylori?

Gram negative

23

What factors determine the outcome of a H. pylori infection?

Site of colonisation
Characters of the bacteria
Host factors

24

What percentage of people infected with H. pylori will be asymptomatic or have chronic gastritis?

> 80%

25

What percentage of people infected with H. pylori will have intestinal metaplasia or chronic atrophic gastritis?

15-20%

26

What percentage of people infected with H. pylori will develop gastric cancer or MALT lymphoma?

< 1%

27

H. pylori can only colonise what mucosa?

Gastric type mucosa

28

What investigations are done to diagnose H. pylori?

Serology - IgG against H. pylori
Urea breath test
Stool antigen test
Gastric biopsy - histology and culture
Rapid slide urease test

29

What outcomes can chronic H. pylori infection lead to?

Antral predominant gastritis, increased acid and duodenal disease
Mild mixed gastritis with normal acid levels and no significant disease
Corpus predominant gastritis, decreased acid and gastric atrophy progressing to gastric cancer