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Helicobacter pylori and Gastric Disease Flashcards

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1
Q

Dyspepsia can describe a range of symptoms. List examples

A 
Pain/discomfort in abdomen
Nausea and vomiting
Bloating
Retrosternal pain
Anorexia
Fullness, early satiety
Heartburn
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2
Q

What is the two broad classification of causes of dyspepsia?

A

Organic

Functional

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3
Q

Groups of causes of dyspepsia

A 
Upper GI - peptic ulcer, gastritis, non-ulcer dyspepsia, gastric cancer
Hepatic causes
Gallstones
Pancreatic disease
Lower GI - IBS, colonic cancer
Coeliac
Psychological 
Drugs
Systemic disease
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4
Q

Symptoms that indicate a referral when patient presents with dyspepsia

A 
ALARMS
Anorexia
Loss of weight (unintentional)
Anaemia
Recent onset and over age 55
Melaena, haematemesis
Mass
Swallowing - dysphagia
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5
Q

What investigations are used to diagnose gastric disease?

A

History
Examination
Upper GI Endoscopy
Bloods - FBC, ferritin, LFTs, U&Es, calcium, glucose, coeliac serology/IgA

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6
Q

What drugs and medications are useful in GI history?

A 
NSAIDs
Steroids
Bisphosphonates
Ca antagonists
Nitrates
Theophyllines
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7
Q

Which lifestyle factors need to be addressed in GI history?

A 
Alcohol
Smoking
Diet
Exercise
Weight reduction
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8
Q

When presenting with dyspepsia, which factors indicate testing for H.pylori?

A

No ALARM symptoms

Under 55 years old

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9
Q

What type of bacterium is h pylori?

A

Gram negative, spiral, microaerophillic, flagellated

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10
Q

What tissue does h pylori colonise?

A

Gastric muscosa - burrows into mucus layer, does not penetrate epithelial layer

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11
Q

What substance is produced by h pylori?

A

Urease

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12
Q

4 clinical outcomes of h.pylori infection

A

Asymptomatic or chronic gastritis
Chronic atrophic gastritis - intestinal metaplasia
Gastric or duodenal ulcer
Gastric cancer - MALT lymphoma

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13
Q

Infection resulting in increased acid production will result in which type of disease?

A

Duodenal disease

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14
Q

Infection of h pylori resulting in decreased gastric acid production will result in which type of disease?

A

Gastric cancer - gastric atrophy

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15
Q

Non-invasive diagnostic investigations for h.pylori infection

A

Serology - IgG
13d/14c Urea Breath test
Stool Antigen test - ELISA

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16
Q

Invasive diagnostic investigation for h.pylori infection?

A

ENDOSCOPY
Biopsies
Culture
Rapid slide urease test (changes yellow to pink)

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17
Q

What indicates a positive result in a rapid slide urease test?

A

Change from yellow to pink

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18
Q

How is gastritis diagnosed?

A

Histological diagnosis

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19
Q

What are 3 causes of gastritis?

A

Autoimmune
Bacterial
Chemical

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20
Q

Causes of peptic ulcers

A 
H.pylori
NSAIDs
Smoking
Zollinger-Ellison
Hyperparathyroidism
Crohns
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21
Q

How does hyperparathyroidism lead to peptic ulcer disease?

A

Increased Ca
Increased Ach
Increased Gastrin
Increased gastric acid secretion –> Peptic ulcer

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22
Q

What is Zollinger-Ellison?

A

Gastrin producing neuroendocrine tumour

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23
Q

How does Zollinger Ellison syndrome occur?

A

Sporadic

MEN 1 Associated

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24
Q

Symptoms of zollinger ellsion

A 
Abdominal pain
Diarrhoea
GO reflux
weight loss
bleeding
nausea
vomiting
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25
Diagnostic investigations for zollinger ellison
Serum gastrin Endoscopy EUS MRI liver
26
Treatment for zollinger-ellison syndrome
PPIs
27
Associated symptoms with peptic ulcer disease
``` Epigastric pain which is relieved by antacids Nocturnal/hunger pain Back pain Nausea, occasionally vomiting Weight loss, anorexia Epigastric tenderness Haematemesis, melaena, anaemia ```
28
Treatment of peptic ulcer disease
Eradicate h/pylori infection Antacid medication (PPIs; omeprazole, H2 Receptor antagonists - ranitidine) Stop NSAID uses Surgery if complicated
29
What is eradication therapy for h.pylori?
Triple therapy Clarithromycin Amoxicillin (Metronidazoles) PPI
30
Complications of peptic ulcer disease
``` Acute bleeding Chronic bleeding Perforation Fibrotic stricture Pyloric stenosis Gastric outlet obstruction ```
31
Signs of Gastric outlet obstruction
``` Vomiting Early satiety Abdominal distension Weight loss Gastric splash Dehydration Metabolic alkalosis Bloods - low Cl, low Na, low K, renal impairment ```
32
Diagnostic investigations of Gastric outlet obstruction
UGIE
33
Treatment of gastric outlet obstruction
Endoscopic balloon dilatation | Surgery
34
5 year survival rate of gastric cancer
Less than 20%
35
Most common type of gastric cancer
Adenocarcinoma GI stromal tumor Mucosa associated lymphoid tumour
36
Signs of gastric cancer
``` Dyspepsia Early satiety Nausea & vomiting Weight loss GI bleeding Iron deficiency anaemia Gastric outlet obstruction ```
37
What is the Correa hypothesis?
Most sporadic cancers are of intestinal type
38
What perrcentage of gastric cancers are heritable?
1-3 % | Hereditary Diffuse Gastric Cancer
39
Mode of inheritance of Hereditary Diffuse Gastric Cancer
``` Autosomal dominant CDH1 gene (E-cadherin) ```
40
Management of gastric cancer
Endoscopy and biopsy - Histological diagnosis Staging investigation - CT chest/abdo MDT Treatment - surgery and chemotherapy
41
What is a peptic ulcer?
A break in the lining of the GI tract to the muscularis mucosa
42
Most common location of peptic ulcers
lesser curvature of the proximal stomach or the first part of the duodenum.
43
Which type of ulcers present earlier?
Duodenal - around 20 years
44
How do NSAIDs cause peptic ulcer formation?
Inhibit prostaglandin synthesis - reduces glycoprotein, mucous and phospholipid secretion Lining loses protection from acid
45
What are curling's ulcer and cushing's ulcer?
Physiological stress- risk factor for peptic ulcer disease Curling's - from burns Cushing's from head trauma
46
What is the NICE criteria for urgent referral for upper GI Endoscopy (OesophagoGastroDuodenoscopy) ?
New onset Over 55 with weight loss and upper abdominal pain, reflux or dyspepsia New onset dyspepsia not responding to PPI
47
Classic differentiation between gastric and duodenal ulcers
any pain from a gastric ulcer is exacerbated by eating, whilst duodenal ulcers are worse 2-4 hours after eating or even alleviated by eating
48
Differential diagnoses for peptic ulcer disease
``` ACS GORD Gallstone Gastric malignancy Pancreatitis ```
49
Risk factors for gastric cancer
``` Male H pylori Smoking Increasing Age Alcohol consumption ``` Salt in diet Family history Pernicious anaemia
50
What is trosier sign?
Palpable left supraclavicular node - Virchow's | Indicates metastatic abdominal malignancy
51
Other signs of metastatic disease
Ascites Hepatomegaly Jaundice Acanthosis nigricans
52
What should biopsies be sent for testing in suspected gastric cancer?
Histology – for classification and grading of any neoplasia present CLO test – for the presence of H. Pylori HER2/neu protein expression – this will allow for targeted monoclonal therapies if present
53
What imaging is needed for TNM staging of gastric cancer?
Diagnosis on biopsy from OGD CT Chest Abdo Pelvis Laparoscopy
54
What assessment and support is essential in definitive management of gastric cancer?
Nutritional status - support with feeding | Dietician will assess
55
Curative treatment for gastric cancer
Surgery and perioperative treatment - 3 cycles neoadjuvant and 3 cycles adjuvant
56
Surgical options for gastric cancer
Proximal - Total gastrectomy | Distal - subtotal gastrectomy (antrum or pylorus)
57
Most common reconstruction method in alimentary pathology
Roux en Y
58
Which surgical option may be offered to patients with T1a gastric cancer?
Endoscopic Mucosal Resection
59
Complications of gastrectomy
``` Death Anastomotic leak Re-operation Dumping syndrome Vitamin B12 deficiency ```
60
Palliative management of gastric cancer
Chemotherapy Best Supportive Stenting
61
Complications of gastric cancer
Perforation Iron deficiency anemia Malnutrition Gastric Outlet Obstruction
62
Types of gastrectomy
Subtotal Total with Roux en Y reconstruction Open gastrectomy Laparscopic distal gastrectomy

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