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

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

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1
Q

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

A

Acute gastritis
Chronic gastritis
Rare

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2
Q

What are the causes of acute gastritis?

A 
Irritant chemical injury
Severe bruns
Shock
Severe trauma
Head injury
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3
Q

What are the causes of chronic gastritis?

A

Autoimmune
Bacterial (H pylori)
Chemical

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4
Q

Rare causes of gastritis? (3)

A

Lymphocytic
Eosinophilic
Granulomatous

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5
Q

What antibodies are related to autoimmune chronic gastritis?

A

Anti-parietal and anti-intrinsic factor antibodies

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6
Q

What will be seen on biopsy of autoimmune chronic gastritis?

A

Atrophy and intestinal metaplasia in body of the stomach

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7
Q

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

A

Pernicious anaemia (due to B12 deficiency)

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8
Q

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

A

Yes

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9
Q

What conditions do patients with autoimmune gastritis also have?

A 
Pernicious anaemia (B12 deficiency)
Often neurological symptoms
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10
Q

What is the most common type of chronic gastritis?

A

H. pylori associated chronic gastritis

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11
Q

How does H. pylori cause chronic gastritis?

A

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

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12
Q

What produces the anti-H pylori antibodies?

A

Lamina propria plasma cells

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13
Q

What causes chemical chronic gastritis?

A

NSAIDs
Alcohol
Bile reflux
These cause direct injury to mucus layer

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14
Q

What would be seen on biology of chemical chronic gastritis?

A

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

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15
Q

How does increased acid secretion lead to duodenal ulcers?

A

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

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16
Q

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

A

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

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17
Q

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

A

Increased acid production

Failure of mucosal defence

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18
Q

Edges of peptic ulcers?

A

Clear cut - punched out

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19
Q

Wha are the microscopic layers of a peptic ulcer?

A

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

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20
Q

What type of cancers occur in the stomach?

A

Carcinomas (adencarcinoma)
Lymphomas
Gastrointestinal stromal tumours

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21
Q

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

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A

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

22
Q

What are the 2 subtypes of gastric adenocarcinoma?

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A

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

23
Q

Are gastric ulcers potentially malignant?

24
Q

What is a Kruckenberg tumour?

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A

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) ```
31
What is another name for an OGD?
Endoscopy
32
What is the purpose of performing an endoscopy in a patient with an upper GI bleed? (3)
To identify cause Therapeutic manoeuvres Assess risk of rebleeding
33
What scoring system is used to assess the mortality of a patient with an upper GI bleed?
Rockall risk scoring sustem
34
What is a screening tool to assess the likelihood that a patient with an acute upper gastrointestinal bleeding (UGIB) will need to have medical intervention such as a blood transfusion or endoscopic intervention?
The Blatchford score
35
Management of GI bleed if blatchford score of 0-1 (low risk)?
If no clinical concerns, the patient can be discharged without an endoscopy
36
Management of GI bleed if blatchford score of 2-5 (indeterminate risk)?
Monitor Hb If witnessed significant bleeding or stigmata consider IV omeprazole If stigmata of cirrhosis/ known liver disease give telipressin Reassess to determine need for endoscopy
37
Management of GI bleed if blatchford score is greater than 6?
``` Repeat Hb at regular intervals Give transfusion if needed IV omeprazole if witnessed bleeding or stimgmata If cirrhosis, give telipressin Reverse any coagulopathy Endscopy ```
38
Treatment of bleeding peptic ulcer?
Endoscopic treatment (high risk ulcers) Acid suppression? Surgery H pylori eradication
39
Possible endoscopic treatment of a bleeding peptic ulcer? (5)
``` injection heater probe coagulation Combinations Clips Haemospray ```
40
What can be injected into a bleeding ulcer to stop it bleeding?
Adrenaline
41
How does haemospray work?
When it comes in contact with blood, powder absorbs water then acts both cohesively and adhesively forming a mechanical barrier over the bleeding site
42
What does giving an infusion of omeprazole do when a patient has a bleeding ulcer?
Reduces chance of re-bleed and death
43
Treatment of peptic ulcer after endoscopy stops bleeding?
Omeprazole IV | H pylori eradication
44
Treatment of bleeding peptic ulcer if not able to be stopped by endoscopy?
Surgery
45
Risk factors for varies bleeding?
Portal pressure greater than 1mmHg Varies greater than 25% of oesophageal lame Presence of red signs Degree of liver failure
46
When should you suspect that an upper GI bleed is caused by varices?
Known history of cirrhosis with varies History of chronic alcohol excess, chronic viral hepatitis, metabolic or autoimmune liver disease, intra-abdominal sepsis/ surgery Stigmata of chronic liver disease
47
Achievement of haemostasis in patients with varcies? (5)
``` Telipressin (vasopressin analogue) Endoscopic variceal ligation (banding) Sclerotherapy Sengstaken-Blakemore balloon TIPS ```
48
How is vasopressin given?
Bolus 1-2mg 4 hrly
49
What is sclerotherapy?
an injection of a solution (generally a salt solution) directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot.
50
What is the sengstaken-blakemore tube?
Tube with balloon that is used when endoscopic haemostasis fails Left in patient for 24 hours and puts pressure on bleeding varices
51
What does TIPS involve?
Joining of portal vein and hepatic vein

Study Notes - Gastroenterology (42 decks)

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