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GI > H.Pylori & Gastric Secretion > Flashcards

H.Pylori & Gastric Secretion Flashcards

1
Q

Symptoms of Dyspepsia

A 
Upper Abdominal/Retrosternal pain/discomfort.
Bloating
Reduction in appetite
Heartburn
Burping, Reflux
Nausea/ Vomitting

Lasting >4 weeks

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2
Q

General Causes of Dyspepsia

A 
Drugs
Psychological
Coeliac Disease 
Pancreatic Disease
Hepatic (gallstones)
Upper GI
Lower GI (IBS/Cancer although non-typical presentation)
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3
Q

Upper GI causes of dyspepsia

A

GORD
Peptic Ulcer
Gastric Cancer

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4
Q

What is GORD

A

Gastro-oesophageal reflux disease. Caused by weakening of the lower esophageal sphincter causing gastric acid to leak into the oesophagus.

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5
Q

Describe the investigation for dyspepsia

A

Bloods - FBC, ferritin, lfts, calcium, glucose, coeliac serology/ serum igA

Drug History

Lifestyle - alcohol, diet, smoking, exercise, weight reduction

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6
Q

Drug History - Classes of Drugs to check for:

A

NSAIDS - naproxen, dicolfenac, ibuprofen

Steroids - corticosteroids

Biphosphonates - osteoporosis drugs.

Ca+ antagnoist - CCBs, amplodopine

Nitrates - GTN

Theophyllines

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7
Q

When to refer for endoscopy?

A

ALARMS

A - Anorexia
L - Loss of Weight
A - Anaemia (irondeficiency) 
R - Recent onset >55 years, persistent despite treatment.
M - Melaena/Haematemesis or Mass 
S - Swallowing - Dysphagia
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8
Q

First Step Treatment of Dyspepsia in the absence of ALARMS

A

Antacid Medications - Gavisgon
H2 receptor antagonists - ranitidine

Then:
H.Pylori Test - HPSA test, stopping antibiotics 4 weeks prior, H2RA one day prior. Start Omeprazole.

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9
Q

Steps if H.Pylori test negative

A

If PPI (omeprazole) has resolved after a month, step down therapy.

> 55 refer urgently to Upper GI cancer endoscopy referral.

<55 step up treatment, if still no response refer routinely to GI

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10
Q

Steps if H.Pylori test positive

A

Eradicate H.Pylori with combination of antibiotics/PPI

If symptoms are ongoing, a urea breath test, if positive use second line eradication therapy for H/pylori.

If negative trial PPI treatment,
if still negative refer urgently for cancer upper GI endoscopy.

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11
Q

What is Helicobacter pylori?

A

Gram Negative, microaerobic, spiral shaped (s-shaped) mobile via flagella.

Infects 50% of the world population and is acquired in childhood.

The bacteria colonises in the gastric mucosa and does not penetrate the epithelia layer and evokes immune response in the underlying mucosa

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12
Q

Outcome of H.Pylori Infection.

A

Dependant on site, characteristics of bacteria and host factors.

Asymptomatic
Chronic Gastritis
Gastric/Duodenal Ulcer
Intestinal Metaplasia
Gastric Cancer/MALT Lymphoma
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13
Q

Process of Serology

What Ig is tested in H.Pylori?

A

Examination of blood serum to examine proteins made by the immune system (immunoglobulins)

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14
Q

H.Pylori Non-invasive Testing

A

Serology
Urea Breath Test
ELISA - stool antigen test. (off PPI for two weeks)

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15
Q

H.Pylori invasive testing

A

Histology - gastric biopsies
Culture - gastric biopsise
Rapid slide urease test (CLO)

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16
Q

Define ELISA

A

Enzyme-linked immunosorbent assay. Used to detect antibodies made in response to specific infection

17
Q

Why do we use a urea breath test

A

H.pylori secretes urease which catalyses urea to ammonia.

The patient swallows a tablet containing urea made from isotopic carbon . If H.pylori is present, the urea is broken down into ammonia and CO2.

The CO2 is absorbed and exhaled via the lungs where the isotopic carbon is exhaled.

Isotopic carbon is low in nature, if there is no infection, the test results are negative for infection (isotope negative)

18
Q

Causes of Gastritis

A

Autoimmune - Parietal Cells
Bacterial - H.pylori
Chemical- bile/nsaids.

19
Q

Causes of Peptic Ulcers

A

H.Pylori
NSAIDS
Smoking

Rarely caused bu Hyperparathyroidism, Crohn’s Disease, Zollinger-Ellison Syndrome

20
Q

Define Hyperparathyroidism

A

Overproduction of parathyroid hormone causing hypercalcaemia.

21
Q

Zollinger-Ellison Syndrome

A

Disease where tumors form from the pancreas or the upper duodenum (gastrinomas) which secetre large amounts of gastrin. Causing the stomach to overproduce acid.

22
Q

Symptoms associated with peptic ulcers

A 
Epigastric Pain
Nocturnal/ Hunger (more common in DU)
Back pain (posterior DU)
Nausea and Vomiting
Weight loss and anorexia

Ulcer Bleed may cause haematemesis, melaena or anaemia

23
Q

Treatment of Peptic Ulcers

A

Eradication Therapy.

Antacid - PPI (omerpraole) or H2RA (ranitidine)

Stopping of NSAIDS if possible and provided with other protective agents.

Complications are treated as they arise

24
Q

Antibiotic Treatment of H.Pylori

A

Triple therapy for 7 days.

  • Clarithromycin
  • Amoxicillin (or tetracycline)
  • PPI (omeprazole)

May fail due to ABX resistance or poor compliance. Second line treatment dependant of resistance profiles.

25
Q

Complications of Peptic Ulcers

A

Acute Bleeding - melaena and haematemesis

Chronic Bleeding - iron deficiency anaemia

Performation
Fibrotic Stricture
Gastric Outlet Obstruction (oedema or stricture)

26
Q

Symptoms of Gastric Outlet Obstruction

A 
Vomiting
Weight Loss
Abdominal Distension
Gastric Splash
Early satiety
Metabolic alkalosis
Weight loss
Dehydration (loss of H+ and Cl- in vomit)

Bloods - low Cl, low Na, low K renal impairment.

Diagnosed with UGIE - upper GI endoscopy to identify cause.

27
Q

What is a gastric outlet obstruction?

A

Also known as pyloric obstruction - mechanical obstruction.

28
Q

What causes a gastric outlet obstruction

A

Stricture, Ulcer and Cancer

29
Q

Define metabolic alkalosis

A

A metabolic condition in which pH is raised beyond 7.35-7.45. Increase in serum bicarbonate, caused by loss of H+ from the body or gain in HCO3

30
Q

Treatment of Gastric outlet obstruction

A

Endoscopic balloon dilatation or surgery.

31
Q

Types of Gastric Cancers

A

Majority - Adenocarcinoma
MALT - mucosa associated lymphoid tissue (lymphoma)
GIST GI stromal tumour (soft tissue sarcoma)

32
Q

Presenting Symptoms of Gastric Cancer

A 
Dyspepsia
Early satiety
Nausea and vomiting
weight
loss
GI bleeding 
Iron deficiency anaemia
gastric outlet obstruction
33
Q

Causes of gastric cancer

A

Diet, genetics, smoking, h.pylori, gastric ulcers, family history

34
Q

Gastric Cancer Genes

A

Accounts for 1-3%

HDGC, AD, CDH-1 gene

35
Q

Management of gastric cancer

A

Endoscopy and Biopsy - to make a histological diagnosis.

Staging - CT chest/abdo - lymph nodes and liver/lungs/peritoneum/bone marrow.

MDT discussion

GI (20 decks)

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