H.Pylori and Gastric Disease

Question 1

What is Dyspepsia

Answer 1

Pain or discomfort in the upper abdomen

Question 2

What is the group of symptoms for dyspepsia

Answer 2

upper abdominal discomfort, retrosternal pain,
anorexia, nausea, vomiting, bloating, fullness,
early satiety heartburn

Question 3

What are the causes of dyspepsia

Answer 3

Upper GI and lower GI problems

Gallstones

Pancreatic disease

Coeliac disease

hepatic causes

Psychological

Drugs

Other systemic diseases

Question 4

When should refer someone with dyspepsia for an endoscopy

Answer 4

Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia

Question 5

What features from a history do you need to find out for a patient with dyspepsia

Answer 5

Drugs - do they take any NSAIDS

Lifestyle:
Alcohol, diet, smoke, exercise, weight reduction

Question 6

What bloods are investigated in dyspepsia diagnosis

Answer 6

FBC

ferritin- iron storage

Liver Function Tests

U&Es

calcium

glucose

coeliac serology/serum IgA

Question 7

What Bacterial test in important in diagnosis dyspepsia

Answer 7

Test for Heliobacter pylori

Question 8

What is the treatment if patient with dyspepsia is

Answer 8

Eradication therapy if H.Pylor positive

Treat symptoms with proton pump inhibitors H2R antagonists and lifestyle factors

stop NSAID

Question 9

Where can H. Pylori only colonise

Answer 9

Gastric type mucosa

- therefore resides on mucus layer without penetrating epithelial layer

Question 10

How and where does the H.pylori affect

Answer 10

Evokes an immune response form the underlying mucosa

Question 11

What does the immune response to the H.pylori depend on

Answer 11

site of colonization,

characteristics of bacteria - express different proteins

genetic susceptibility

environmental factors e.g. smoking

Question 12

H.Pylori infection in what part of the stomach increases acid production and has a low risk of gastric cancer

Answer 12

Duodenum

Question 13

What are three non invasive procedures to test for H.pylori

Answer 13

Serology - test for IgG

Urea Breath test

Stool antigent test (need to be of PPI 2 weeks prior)

Question 14

What is the invasive procedure to test for H.Pylor

Answer 14

An Endoscopy:
For Histology or
Culture of gastric biopsies

Rapid slide urease test (CLO)

Question 15

Why is Urea tested for in H.Pylori diagnosis

Answer 15

As H.Pylori releases Urease enzyme that breaks down urea into ammonia and bicarbonate

Question 16

What dies the Urease slide test exactly test for

Answer 16

Ammonia

Question 17

What does the the Urea breath test exactly test for

Answer 17

CO2 in your breath

Question 18

What is the aetiology of peptic ulceration

Answer 18

H.Pylori
NSAIDS
Smoking

Rare:
Zollinger-Ellison syndrome, hyperparathyroidism, Crohn’s disease

Question 19

How does H.Pylori infection increase the acid production

and where is the most likely to occur

Answer 19

Gastric atrophy

Occurs in body and antrum

Question 20

What are the symptoms associate with peptic ulcers

Answer 20

Epigastric pain

Nocturnal/hunger
pain

Back pain
Nausea/vomiting
Weight loss/anorexia

epigastric tenderness

Question 21

What are the potential symptoms if the ulcer bleeds

Answer 21

haematemesis
melaena
anaemia

Question 22

How can back pain occur in peptic ulceration

Answer 22

If duodenal ulcer penetrates the posterior

Question 23

How is the symptoms of epigastric pain relived

Answer 23

Antacids:

Proton pump inhibitor eg omeprazole

H2 receptor antagonists eg ranitidine

Question 24

What is the treatment of Peptic ulcer caused by H.Pylori infection

Answer 24

Eradication
therapy

Surgery - if complicated

Question 25

What medication needs to be stopped in Peptic ulceration

Answer 25

NSAIDS

Question 26

What happens in eradication therapy of H.Pylori infection

Answer 26

Tripple therapy of Clarithromycin 500mg bd Amoxycillin 1g bd or Metronidazole 400mg bd (tetracycline if penicillin allergic) PPI: e.g. omeprazole 20mg bd For 7 days

Question 27

What is the complication of peptic ulceration

Answer 27

Acute/chronic bleeding Perforation Fibrotic stricture (narrowing) Gastric outlet obstruction (leads to oedema or stricture)

Question 28

What is the symptoms of Gastric outlet obstruction

Answer 28

Vomiting – lacks bile, fermented foodstuffs Early satiety, abdominal distension, weight loss, gastric splash Dehydration

Question 29

How does metabolic alkalosis occur in gastric outlet obstruction

Answer 29

Due to the loss of H and Cl ions through vomiting

Question 30

What is the result of a blood test for gastric outlet obstruction

Answer 30

low Cl, low Na, low K, renal impairment

Question 31

What is the causes of gastric outlet obstruction

Answer 31

Stricture Ulcer Cancer

Question 32

What is the potential treatment go gastric outlet obstruction

Answer 32

Endoscopic ballon microscopy | Surgery

Question 33

How is Gastric outlet obstruction diagnosed

Answer 33

Endoscopy

Question 34

What is the symptoms of gastric cancer

Answer 34

``` Dyspepsia, early satiety, nausea & vomiting, weight loss, GI bleeding (iron deficiency /anaemia) gastric outlet obstruction ```

Question 35

What is the aetiology of Gastric cancer

Answer 35

Diet Genetics (however most sporadic) Previous gastric resection Billary reflux Smoking H.Pylori infection Peptic ulcer Pre malignant gastric pathology

Question 36

What is oncogenes that cause the 1-3% of heritable gastric cancers

Answer 36

HDGC AD CDH1 (E-cadherin)

Question 37

What is the two pathways of gastric cancer

Answer 37

Intestinal type | Diffuse type

Question 38

How do you make a histological diagnosis of gastric cancer

Answer 38

endoscopy and biopsies

Question 39

How do you determine the staging of gastric caner

Answer 39

Use imaging to see if its spread Asses patients fitness Determine the histology

Question 40

What imaging technique is used to determine if gastric cancer has spread

Answer 40

Ct of chest/abdomen

Question 41

Where are the potential places that gastric cancer can spread

Answer 41

``` lymph nodes liver lungs peritoneum bone marrow ```

Question 42

How do you treat gastric cancer

Answer 42

Surgical and chemotherapy

Question 43

What cell type of gastric cancer

Answer 43

Adenocarcinoma