H. Pylori + Gastric Disease Flashcards by Sophia Boyce

What are the functions of the stomach?

Storage 
Start digestion 
Acid secretion 
Secretion of intrinsic factor
Secretion of enzymes (e.g. pepsin)

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What is dyspepsia?

General term to describe a group of symptoms causing pain/discomfort in upper abdomen

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Describe the 9 symptoms than can be included in dyspepsia

pain/discomfort in upper abdomen
retrosternal pain
anorexia
nausea
vomiting
bloating
fullness
early satiety
heartburn

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What percentage of people have dyspepsia?

80%; majority with no underlying disease

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What medical professionals generally treats dyspepsia symptoms?

GP; community pharmacist

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What are 4 upper GI causes of dyspepsia?

Peptic ulcer, gastritis, non-ulcer dyspepsia, gastric cancer

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Name 3 other organ related cause of dyspepsia?

Hepatic causes
Gallstones
Pancreatic disease

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Name 2 lower GI causes of dyspepsia?

IBS, colonic cancer

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Name 3 other causes of dyspepsia

Coeliac, psychological, drugs

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What types of systemic disease cause dyspepsia?

Metabolic (high Ca; diabetes)

Cardiac (retrosternal heaviness - IHD)

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What is the acronym for red flag symptoms for when to refer for endoscopy?

Anorexia
Loss of weight
Anaemia - iron deficiency (could be lesion bleeding in upper GI)
Recent onset > 55 years or persistent despite treatment (could be cancer)
Melaena/haematemesis
Swallowing problems/dysphagia

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What are the conditions of an upper GI endoscopy?

local anaesthetic/sedation, day case, fasted, consent

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What are the risks of an upper GI endoscopy?

1:2000 perforation, bleeding, reaction to drugs given

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What are the 4 elements of investigations into someone with dyspepsia?

History + examination
Bloods
Drug history
Lifestyle

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What bloods might you request for someone with dyspepsia?

FBC, ferritin, LFTs, U+Es, calcium, glucose, coeliac serology/serum IgA

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What drugs should be asked about in drug history of someone with dyspepsia?

NSAID (brufen, nurofen, ibruprofen, naproxen)
Steroids
Bisphosphonates (osteoporosis - large tablet)
Ca antagonists
Nitrates
Theophyllines
remember OTC

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What aspect of lifestyle should be explored?

Alcohol, diet, smoking, exercise, weight reduction

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What type of bacteria is H. pylori?

gram neg, microaerophillic, flagellated

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Where can H. pylori only colonise?

Gastric type mucosa (stomach) - surface mucous layer not epithelial layer; burrows in to get away from gastric acid

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What is H. pylori categorised as?

Type I carcinogen

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What is H. pylori effect on epithelial cells?

Cannot go through them but has an effect on those which sit close to it

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What is H. pylori mechanism?

It is urease positive - breaks down surrounding substrates and creates a halo of alkilinity

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What are 4 clinical outcomes of H. pylori infections?

Study These Flashcards

Asymptomatic/chronic gastritis (>80%)
Chronic atrophic gastritis; intestinal metaplasia 
Gastric/duodenal ulcer 
(15-20%)
Gastric cancer/MALT lymphoma (<1%)

What is the outcome of H. pylori infection dependent on?

Study These Flashcards

Site of colonisation
Characteristics of bacteria (some more virulent)
Host factors e.g. host susceptibility and other environmental factors e.g. smoking

What is the outcome of antral predominant gastritis from chronic H. pylori infection?

Increased acid, low risk of gastric carcinoma - results in DU disease (ulcer etc)

What is the outcome of mild mixed gastritis from chronic H. pylori infection?

Normal acid - no significant disease

What is the outcome of corpus predominant gastritis from chronic H. pylori infection?

Decreased acid, gastric atrophy - gastric carcinoma (or gastric ulcer)

What are 3 non-invasive tests for H. pylori infection?

Serology: IgG against H. pylori 13C /14C urea breath test STOOL ANTIGEN TEST - ELISA - need to be off PPI for 2 weeks

What are 3 invasive tests for H. pylori infection?

Histology: gastric biopsies stained for bacteria Culture of gastric biopsies RAPID SLIDE UREASE TEST (CLO) - ammonia - urease present = H. pylori present = pink

What is gastritis?

Inflammation in gastric mucosa

What are the three types and their associated causes?

Autoimmune - parietal cells Bacterial - H. pylori Chemical - bile/NSAIDs

What are the majority of peptic ulcers caused by?

H. pylori

What are 2 other possible causes of peptic ulcers?

NSAIDs | Smoking

Name 3 other conditions which peptic ulcers are rarely caused by?

Zollinger-Ellison syndrome Hyperparathyroidism Crohn's

Name 5 symptoms associated with peptic ulcers? (E, N, B, N, W)

Epigastric pain (main feature - may be only symptom) Nocturnal/hunger pain (more DU) Back pain (suggests penetration of posterior DU) Nausea/occasionally vomiting Weight loss + anorexia

What may patients present with if a peptic ulcer bleeds?

Haematemesis and/or melaena (acute) | Anaemia (chronic)

Investigation for peptic ulcer?

endoscopy

Why are ulcers biopsied?

to establish they are benign

How are peptic ulcers treated?

H. pylori eradication Antacid meds (PPI or H2 receptor agonist (ranitidine)) Stop NSAID if involved Surgery only in complicated PUD

How to eradicate H. pylori?

TRIPLE THERAPY FOR 7 DAYS | Clarithromycin, amoxycillin (tetracycline in pen allergy), PPI (omeprazole)

Why are PPI involved in H pylori triple therapy?

To protect stomach from excess acid production

What is the success rate for H. pylori infection?

90% of cases

5 potential complications of peptic ulcers?

``` Acute bleeding Chronic bleeding Perforation Fibrotic stricture Gastric outlet obstruction ```

How does gastric outlet obstruction arise in peptic ulcers?

if pyloric sphincter is affected

Symptoms of gastric outlet obstruction?

Vomiting (main symptom - lacks bile + foodstuff) Early satiety, distension, weight loss, gastric splash Metabolic alkalosis

What would the bloods result be in someone with gastric outlet obstruction?

low Cl, low Na, low K, renal impairment

How is gastric outlet obstruction officially diagnosed?

UGIE (identify cause - structure, ulcer, cancer)

How is gastric outlet obstruction treated?

Endoscopic balloon dilatation, surgery

What is the prognosis for gastric cancer?

5-year survival <20%

Gastric cancer presents late in western countries, why?

asymptomatic initially

What histological type are most gastric cancers?

Adenocarcinoma (epithelial cells)

How does a person with gastric cancer generally present?

``` Dyspepsia Early satiety Nausea + vomit Weight loss GI bleeding Anaemic GOO ```

Investigations for gastric cancer?

Endoscopy w biopsy | CT chest + abdo to stage

Treatment for gastric cancer?

surgery | chemo

What are aetiologies for gastric cancer?

``` H. pylori infection Familial Previous gastric resection Biliary reflux Premalignant gastric pathology Smoking Some food groups e.g. high salt, high nitrate ```

H. Pylori + Gastric Disease Flashcards

(55 cards)