H Pylori and Gastric Disease

Question 1

Upper GIT consists of what?

Answer 1

Oesophagus

Stomach

Question 2

What is the function of the stomach?

Answer 2

Storage, digestion, defence, secretion, intrinsic factor

Question 3

What is dyspepsia?

Answer 3

A group of symptoms:

Pain/discomfort in upper abdomen

Question 4

What symptoms make up dyspepsia?

Answer 4

Upper abdomen discomfort
Retrosternal pain
Nausia/vom
Bloating/fullness
Early satiety

Question 5

What is organic disease?

Answer 5

A visible, definitive pathology

Question 6

What is functional disease?

Answer 6

Normal cells + structure with incorrect function

Question 7

What is the pnemonic for when to refer to endoscopy?

Answer 7

ALARMS

Question 8

What does ALARMS stand for

Answer 8

Anorexia
Loss of weight
Anaemia
Resent onset >55, persistent
Melaena/haemoptysis or Mass
Swallowing dysphagia

Question 9

What to do in presentation of dyspepsia?

Answer 9

History+examination
Blood
Drug History
Lifestyle

Question 10

What blood examinations are made in a patient presenting with dyspepsia?

Answer 10

FBC, LFT, U+E
Ferritin
Glucose
Calcium
Coeliac serology

Question 11

A patient with dyspepsia and high LFTs is suggestive of what?

Answer 11

Liver disease

Gallstones

Question 12

What drugs increase the risk of dyspepsia?

Answer 12

NSAIDSs
Steroids
Bisphosphonates
Ca antagonists
Nitrates

Question 13

When is an upper GI endoscopy indicated in dyspepsia?

Answer 13

Alarm features

>55

Question 14

What do you test for in a dypepsia patient, no alarm features, <55?

Answer 14

Helicobacter pylori

Question 15

What is the indicated therapy if H pylori positive?

Answer 15

Eradication therapy

Symptomatic therapy

Question 16

What type of bacteria is H pylori?

Answer 16

Gram -ve, spiral shaped, microaerophilic

Question 17

How does H. pylori colonise the stomach?

Answer 17

Penetrates only the mucus layer, not the epithelial layer of antrum or corpus

Question 18

How does H. pylori survive in the stomach?

Answer 18

Production of urease (alkali halo)

Question 19

How does H. pylori cause disease?

Answer 19

Triggering if immune response in underlying mucosa

Question 20

What does H. pylori cause in 80% of patients?

Answer 20

Asymptomatic

Chronic gastritis

Question 21

What does H. pylori cause in 15-20% of patients?

Answer 21

Atrophic gastritis

Gastric/duodenal ulcer

Question 22

What does H. pylori cause in 1% of patients?

Answer 22

Gastric cancer

MALT lymphoma

Question 23

What factors effect the outcome of H pylori infection?

Answer 23

Colonisation site
Host factors
Environmental factors

Question 24

Antral predominent gastritis increases the risk of what?

Answer 24

Duodenal disease

Question 25

Corpus predominant gastritis increases the risk of what?

Answer 25

Gastric cancer

Question 26

Non-invasive tests for H. pylori

Answer 26

Serology: H. pylori IgG | Stool antigen - ELISA

Question 27

What is the invasive test for H. pylori?

Answer 27

Rapid slide urease test (CLO)

Question 28

What are the potential causes of Gastritis?

Answer 28

A - autoimmune B - Bacterial C - chemical (bile/nsaid)

Question 29

The majority of peptic ulcers are caused by what?

Answer 29

H. pylori NSAIDs Smoking

Question 30

Symptoms of peptic ulcer

Answer 30

``` Epigastric pain Nocturnal hunger/pain Back pain Nausea/vom Weight loss ```

Question 31

How may a patient present with a bleeding ulcer?

Answer 31

Haematemesis Melaena Anaemia

Question 32

Treatment for peptic ulcer

Answer 32

Eradication therapy PPI, H2A Stopping NSAIDs Surgery if complicated

Question 33

What is the eradication therapy for H. pylori?

Answer 33

(Triple therapy, 7 days) Clarithromycin Amoxycillin or metronidazole PPI

Question 34

What drug is given in place for amoxycillin if the patient is penicillin allergic?

Answer 34

Tetracycline

Question 35

Complications of peptic ulcer

Answer 35

``` Acute bleed Chronic bleed Perforation Fibrotic stricture Obstruction ```

Question 36

What are the symptoms of gastric outlet obstruction?

Answer 36

``` Vomiting - no bile, fermented food Early satiety, distension, weight loss Dehydration, loss of acid in vom Alkalosis Gastric splash ```

Question 37

Why does metabolic alkalosis appear in gastric outlet obstruction?

Answer 37

Vomiting out H+ and Cl-

Question 38

Blood results in gastric outlet obstruction?

Answer 38

Low Cl- Low Na Low K Renal impairment

Question 39

How is a gastric outlet obstruction diagnosed?

Answer 39

Upper GI endoscopy | cause found

Question 40

Treatment for gastric outlet obstruction?

Answer 40

Stricture - balloon | Ulcer/tumour - surgery

Question 41

Prognosis of gastric cancer?

Answer 41

5 year suvival <20%

Question 42

What type of cancer occurs in most gastric cancers?

Answer 42

Adenocarcinoma

Question 43

How does gastric cancer present?

Answer 43

``` Dypepsia Early satiety Naus/vom Weight loss GI bleed Fe deficient anaemia Obstruction ```

Question 44

What is the cause of the majority of gastric cancers?

Answer 44

Sporadic with no discernible inherited component

Question 45

What are <15% of gastric cancers called?

Answer 45

Familial, definitive germline mutation

Question 46

What are 1-3% of gastric cancers caused by?

Answer 46

Cancer syndromes

Question 47

How is gastric cancer managed?

Answer 47

Histology diagnosis Staging investigations (CT abdo/chest) MDT discussion Surgery/chemotherapy