*Oesophageal and Stomach disorders 3 (lectures 5 and 6) Flashcards Preview

Study Notes - Gastroenterology > *Oesophageal and Stomach disorders 3 (lectures 5 and 6) > Flashcards

Flashcards in *Oesophageal and Stomach disorders 3 (lectures 5 and 6) Deck (51)
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1

What are the 3 main groups of inflammatory disorders of the stomach?

Acute gastritis
Chronic gastritis
Rare

2

What are the causes of acute gastritis?

Irritant chemical injury
Severe bruns
Shock
Severe trauma
Head injury

3

What are the causes of chronic gastritis?

Autoimmune
Bacterial (H pylori)
Chemical

4

Rare causes of gastritis? (3)

Lymphocytic
Eosinophilic
Granulomatous

5

What antibodies are related to autoimmune chronic gastritis?

Anti-parietal and anti-intrinsic factor antibodies

6

What will be seen on biopsy of autoimmune chronic gastritis?

Atrophy and intestinal metaplasia in body of the stomach

7

What type of anaemia will patients with autoimmune chronic gastritis have?

Pernicious anaemia (due to B12 deficiency)

8

Do patients with autoimmune chronic gastritis have an increased risk of malignancy?

Yes

9

What conditions do patients with autoimmune gastritis also have?

Pernicious anaemia (B12 deficiency)
Often neurological symptoms

10

What is the most common type of chronic gastritis?

H. pylori associated chronic gastritis

11

How does H. pylori cause chronic gastritis?

It inhabits a niche between the epithelial cell surface and mucous barrier
If not cleared then a chronic active inflammation ensues
IL-8 is critical to this

12

What produces the anti-H pylori antibodies?

Lamina propria plasma cells

13

What causes chemical chronic gastritis?

NSAIDs
Alcohol
Bile reflux
These cause direct injury to mucus layer

14

What would be seen on biology of chemical chronic gastritis?

Marked epithelial regeneration, hyperplasia, contestation and little inflammation
(may produce congestion and little inflammation)

15

How does increased acid secretion lead to duodenal ulcers?

Excess acid in duodenum produces gastric metaplasia and leads to H. pylori infection, inflammation, epithelial damage and ulceration

16

Why are you more likely to get ulcers in the duodenum compared with the stomach?

The duodenum is built for absorption, not protection like the stomach

17

What 2 factors are important in the development of chronic peptic ulcers?

Increased acid production
Failure of mucosal defence

18

Edges of peptic ulcers?

Clear cut - punched out

19

Wha are the microscopic layers of a peptic ulcer?

Floor of necrotic fibrinopurulent debris
Base of inflamed granulation tissue
Deepest layer is fibrotic scar tissue

20

What type of cancers occur in the stomach?

Carcinomas (adencarcinoma)
Lymphomas
Gastrointestinal stromal tumours

21

What are 4 other premalignant conditions of the stomach, other than H pylori?

pernicious anaemia
Partial gastrectomy
HNPCC/ lynch syndrome
Menetrier's disease (large folds in stomach)

22

What are the 2 subtypes of gastric adenocarcinoma?

Intestinal type - exophytic/ polypoid mass (easier to treat)
Diffuse type - expands/ infiltrates stomach wall
15% are mixed

23

Are gastric ulcers potentially malignant?

Yes

24

What is a Kruckenberg tumour?

malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast.[1] Gastric adenocarcinoma, especially at the pylorus, is the most common source

25

What type of gastric lymphoma do patients get?

Mucosa associated lymphoid tissue (MALT)

26

What is MALT gastric lymphoma associated with?

H pylori - continuous inflammation induces an evolution into a clonal B-cell proliferation

27

What happens if you treat H pylori in patients with MALT?

It regresses 95% of the time

28

What are the most common causes of upper GI bleeding?

Duodenal ucer
Gastric erosions
Gastric ulcer
Varices
Mallory-weiss tear
oesophagitis
erosive duodenitis
Neoplasm
Stomal ulcer
Oesophageal ulcer

29

What is the most important initial treatment of a patient with an upper GI bleed?

Resuscitation (A, B, C) - O2, IV access, fluids
Prompt endoscopy

30

What is the "100 rule" for poor prognosis with a haemorrhage?

Systolic BP less than 100mmHg
Pulse less than 100/min
Hb less than 100g/L
Age greater than 60
Comorbid disease
Postural drop in blood pressure
(be cautious of young people, diabetics and patients on beta blockers)