H.Pylori and Gastric Disease

Question 1

What are the functions of the stomach?

Answer 1

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

Question 2

What is dyspepsia?

Answer 2

Group of symptoms used to describe pain or discomfort in the upper abdomen

Question 3

What symptoms are included in dyspepsia?

Answer 3

Heart burn
Bloating
Fullness

Question 4

What are some upper GI causes of dyspepsia?

Answer 4

Peptic ulcer
Gastric
Non ulcer dyspepsia
Gastric cancer

Question 5

What is a hepatic cause of dyspepsia?

Answer 5

Gallstones

Question 6

What are some lower GI causes for dyspepsia?

Answer 6

IBS

Colonic cancer

Question 7

What is meant by the term organic?

Answer 7

Means there is a structural pathology that is driving the symptoms

Question 8

What is meant by the term functional disorder?

Answer 8

Structurally everything is okay however not functioning as it should

Question 9

What are the red flag symptoms that require further investigation?

Answer 9

Anorexia 
Loss of weight 
Anaemia 
Recent onset or persistent despite treatment 
Melena 
Swallowing problems

Question 10

What are the requirements before performing an endoscopy?

Answer 10

Local anaesthetic
Fasted
Gained consent

Question 11

What are the investigations for presenting dyspepsia?

Answer 11

History 
Full examination 
Bloods 
FBC 
Ferritin 
Calcium 
Glucose 
Coeliac serum 
Drug history (NSAIDS ect..)
Lifestyle - smoking, alcohol, diet ect..

Question 12

Is H.pylori gram positive or negative?

Answer 12

Negative

Question 13

When can H.pylori only colonise?

Answer 13

In the stomach

Question 14

When would H.pylori be tested for?

Answer 14

When no alarm features are present
Patient is under 55
No UGIE to be performed

Question 15

What % of the world population is infected with H.pylori?

Answer 15

50%

Question 16

Where does H.pylori reside in the stomach?

Answer 16

In the surface mucous layer

should not penetrate the epithelium

Question 17

In 15-20% of those with H.pylori what can develop?

Answer 17

Gastric ulcers

Question 18

In <1% of those with H.pylori what can develop?

Answer 18

Gastric cancer

Question 19

If H.pylori lives in the antrum what is more likely to develop?

Answer 19

Ulcer

Question 20

Where in the stomach is H.pylori more likely to develop in to gastric cancer?

Answer 20

In the body of the stomach

Question 21

How is diagnosis of H.pylori made non-invasively?

Answer 21

Serology: IgG against H.pylori

Stool antigen test

Question 22

How is diagnosis of H.pylori made invasively

Answer 22

Requires endoscopy
Histology
Culture of gastric biopsies
CLO

Question 23

What is gastritis?

Answer 23

Inflammation in the gastric mucosa

Question 24

What are the 3 types of gastritis?

Answer 24

Autoimmune
Bacterial
Chemical

Question 25

What is an example of autoimmune gastritis?

Answer 25

Attack on parietal cells

Question 26

What is an example of bacterial gastritis?

Answer 26

That caused by H.pylori

Question 27

What is potential cause of chemical gastritis?

Answer 27

NSAIDS

Question 28

What are the majority of peptic ulcers caused by?

Answer 28

H.pylori infection

Question 29

Are peptic ulcers more common in men or women?

Answer 29

Men

Question 30

What is another potential cause of peptic ulcers?

Answer 30

NSAIDS

Question 31

What are the symptoms of gastric ulcers?

Answer 31

``` Epigastric pain Pain worse at night Nausea and occasional vomiting Only sign may be epigastric tenderness Haematemesis ```

Question 32

What would haematemesis suggest?

Answer 32

Bleeding of the ulcer

Question 33

What would back pain with gastric ulcers suggest?

Answer 33

May suggest penetration of the posterior DU

Question 34

What is the investigation for gastric ulcers?

Answer 34

Endoscopy

Question 35

Why do gastric ulcers have to be biopsied?

Answer 35

To establish that they are benign

Question 36

What is the treatment for gastric ulcers?

Answer 36

Get rid of H.pylori infection Anti acid medication NSAID removal (if applicable) Surgery in complicated PUD

Question 37

What is the treatment for eradication of H.pylori infection?

Answer 37

Triple therapy for 7 days Clarithromycin Amoxycillin PPI

Question 38

Why are PPI part of the triple therapy?

Answer 38

To protect the stomach from excess acid production

Question 39

How effective is triple therapy for H/pylori treatment?

Answer 39

90%

Question 40

What are potential complications of Peptic ulcers?

Answer 40

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

Question 41

What would signs of chronic ulcer bleeding be?

Answer 41

Iron deficiency | Anaemia

Question 42

What would signs of acute ulcer bleeding ben?

Answer 42

Melaena | Hematemesis

Question 43

Where would the ulcer be located if there was gastric outlet obstruction?

Answer 43

If the pyloric sphincter is affected

Question 44

What are the symptoms of gastric outlet obstruction?

Answer 44

Vomiting Easily satiety Lose weight Metabolic alkalosis

Question 45

What is the prognosis of gastric cancer?

Answer 45

5yr survival <20%

Question 46

Why does gastric cancer present quite late?

Answer 46

Cause it is asymptomatic

Question 47

What type of cancer are the majority of gastric cancers?

Answer 47

Adenocarcinomas

Question 48

How does gastric cancer present?

Answer 48

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

Question 49

What is the investigation to diagnose gastric cancer?

Answer 49

Endoscopy with biopsy

Question 50

What is the investigation to stage gastric cancer?

Answer 50

CT chest and abdo

Question 51

What are the treatments for gastric cancer?

Answer 51

Surgery | Chemotherapy

Question 52

What are some aetiologies for gastric cancer?

Answer 52

``` FH Previous gastric resection Mostly sporadic Biliary reflux Premalignant gastric pathology ```