Helicobacter pylori and gastric disease

Question 1

What is dyspepsia?

Answer 1

A group of symptoms rather than a disease

Question 2

What symptoms come under the term dyspepsia?

Answer 2

Upper abdo discomfort
Retrosternal pain
Anorexia
Nausea
Vomiting
Bloating
Bloating
Fullness
Early satiety
Heartburn

Question 3

What can cause dyspepsia in the upper GI tract?

Answer 3

Peptic ulcer
Gastritis
Non ulcer dyspepsia
Gastric cancer

Question 4

What can cause dyspepsia in the lower GI tract?

Answer 4

IBS

Colonic cancer

Question 5

What are the non GI tube causes of dyspepsia?

Answer 5

Hepatic causes
Gallstones
Pancreatic disease
Coeliac
Metabolic and cardiac diseases
Drugs
Psychological

Question 6

When would a patient presenting with dyspepsia be referred for an endoscopy?

Answer 6

Anorexia
Loss of weight
Anaemia
Recent onset or persistent despite treatment
Melaena or haematemesis

Question 7

What would be done if a patient presented with dyspepsia?

Answer 7

History and exam
Bloods
Drug history
Lifestyle history

Question 8

What bloods would be done on a patient presenting with dyspepsia?

Answer 8

FBC
Ferritin
LFTs
U+Es 
Ca
Glucose
Coeliac serology

Question 9

What drugs would you look out for in a patient presenting with dyspepsia?

Answer 9

NSAIDs
Steroids
Bisphosphates
Ca antagonists
Nitrates
Theophyllines

Question 10

What lifestyle elements would you look out for in a patient presenting with dyspepsia?

Answer 10

Alcohol
Diet
Smoking
Exercise
Weight reduction

Question 11

What is Heliocobacter pylori?

Answer 11

Gram negative, microaerophillic flagellated spiral shaped bacteria

Question 12

Where does H pylori reside?

Answer 12

Gastric type mucosa in surface mucus layer

Question 13

What are the outcomes of H pylori colonisation?

Answer 13

80%- asymptomatic or have chronic gastritis
19%- Gastric/duodenal ulcers or chronic atrophic gastritis
1%- gastric cancer

Question 14

What is the outcome of H pylori colonisation dependent on?

Answer 14

Site of colonisation
Characteristics of bacteria
Host factors
Environmental factors

Question 15

What are the noninvasive methods of diagnosis for H pylori infection?

Answer 15

IgG against H pylori
Urea breath test
Stool antigen test

Question 16

What are the invasive methods of diagnosis for H pylori infection?

Answer 16

Endoscopy

Question 17

How is endoscopy used for diagnosis of H pylori?

Answer 17

Gastric biopsies stained and/or cultured

Rapid slide urease test

Question 18

What is gastritis?

Answer 18

Inflammation of gastric mucosa

Question 19

What are peptic ulcers caused by?

Answer 19

H pylori most commonly
NSAIDs, smoking
Rarely caused by other conditions

Question 20

What are the symptoms of peptic ulcers?

Answer 20

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

Question 21

What is the treatment for peptic ulcers?

Answer 21

Eradicate H pylori if present
Antacid medication
Stop NSAIDs
Surgery in severe cases

Question 22

How is H pylori eradicated in peptic ulcers?

Answer 22

Triple therapy for 7 days- clairythromycin, amoxicillin (or tetracycline) and a proton pump inhibitor e.g. omeprazole

Question 23

What are the 2 kinds of antacid used in treatment of peptic ulcers?

Answer 23

Proton pump inhibitors

H2 receptor antagonists

Question 24

How are peptic ulcers treated in a patient who needs to remain on their NSAIDs?

Answer 24

As usual but NSAIDs carried on with extra protection

Question 25

What are the complications of peptic ulcers?

Answer 25

``` Acute bleeding Chronic bleeding Perforation Fibrotic structure causing narrowing Gastric outlet obstruction ```

Question 26

What are the possible symptoms of acute bleeding in peptic ulcers?

Answer 26

Haemetemesis | Melaena

Question 27

What is the possible effect of chronic bleeding in peptic ulcers?

Answer 27

Iron deficiency anaemia

Question 28

What are the symptoms of gastric outlet obstruction?

Answer 28

``` Recurrent vomiting Early satiety Abdo distension Weight loss Gastric splash Dehydration Loss of H+ and Cl- Metabolic alkalosis ```

Question 29

How can vomiting causing by gastric outlet obstruction be identified?

Answer 29

Lacks bile | Contains fermented foods

Question 30

What would bloods of a patient with gastric outlet obstruction show?

Answer 30

Low CL, Na and K | Renal impairment

Question 31

How is gastric outlet obstruction diagnosed?

Answer 31

Endoscopy

Question 32

What are the causes of gastric outlet obstruction?

Answer 32

Stricture Ulcer Cancer

Question 33

How is gastric outlet obstruction treated?

Answer 33

Balloon dilatation in stricture | Surgery

Question 34

What is the presentation of gastric cancer?

Answer 34

``` Dyspepsia Early satiety Nausea and vomiting Weight loss GI bleeding Anaemia Gastric outlet obstruction ```

Question 35

What are the causes of gastric cancer?

Answer 35

``` Diet Genetics H pylori Previous gastric resection Biliary reflux Premalignant gastric pathology ```

Question 36

How is gastric cancer diagnosed?

Answer 36

Endoscopy | Biopsies

Question 37

What staging investigation is done for gastric cancer?

Answer 37

CT chest/adbo

Question 38

Where does gastric cancer primarily spread to?

Answer 38

Lymph nodes Liver/lungs Peritoneum Bone marrow

Question 39

What is the treatment of gastric cancer?

Answer 39

Surgical and chemo