Session 5 - Disorders of the Stomach Flashcards Preview

Semester 3 - Gastrointestinal > Session 5 - Disorders of the Stomach > Flashcards

Flashcards in Session 5 - Disorders of the Stomach Deck (53):
1

Name four common disorders of the stomach

• Gastritis
• Gastric/duodenal ulceration
• Gastric cancer
• Gastro-oesophageal reflux disease

2

What is the main symptom of gastric/duodenal ulceration?

• Upper abdominal pain

3

Give three complications of gastric/duodenal ulceration

• Bleeding
• Perforation
• Gastric outlet obstruction

4

What is gastritis?

• Mucosal inflammation
• Mucosal breakdown

5

What is GORD?

• Anti-reflux mechanism fail and there is prolonged contact of gastric juices with lower oesoophageal mucosa

6

Give four physiological adaptions designed to prevent reflux

• Lower oesophageal sphincter – which is usually closed and transiently relaxes as part of physiology of swallowing to allow bolus to move into stomach
• Oesophagus enters stomach in abdominal cavity
• Pressure in abdominal cavity is higher than that of thoracic
• Right crus of diaphragm acts as sling around the lower oesophagus

7

Give a clinical feature of GORD

• Dyspepsia
○ Worse on lying down, bending over and when drinking hot drinks

8

How is GORD investigated?

• Clinical diagnosis made on history alone
• Investigations used if dyshagia present or hiatus hernia suspected

9

What are two overarching methods of managing GORD?

• Lifestyle
• Medication

10

Give three changes in lifestyle which can prevent GORD

• Lose weight
• Stop smoking
• Reduce alcohol intake
• Reduce consumption of aggravating foods

11

Give four medications which can be used to medicate GORD

• Simple antacids (CaCO3)
• Raft antacids (Gaviscone, creates protective raft which sits on top of stomach contents to prevent reflux
• PPI
• H2 antagonist

12

Give a complication of GORD

• Barrets-oesophagus
• Stratified squamous cells -> Gastric cells

13

Why do anti-cholinergics increase risk of GORD?

• Relax LOS

14

What proportion of population over 50 have gastric leiomyoma?

• 50%

15

What is a gastric leiomyoma?

• Benign tumour which is often accidentally discovered

16

What is the frequency of gastric carninoma?

• 15/100,000

17

What are the main symptoms of gastric carcinoma?

• Abdominal pain
• Weight loss
• NAV (nausea, vomiting, anorexia)
Anaemia

18

How is gastric carcinoma diagnosed?

• Endoscopy
• Barium meal

19

What are two types of gastric carcinoma?

• Glandular adenocarcinoma
• Diffuse, spreading type adenocarcinoma

20

What is chronic gastritis?

• Chronic inflmmation of stomach lining

21

What is a key symptom of chronic gastritis?

• pernicious anaemia

22

How does pernicous anaemia come about as a result of chronic gastritis?

• Loss of parietal cells
• Less intrinsic factor
• Less absorption of B12 (needs intrinsic factor)
• Down with RBC

23

What is peptic ulcer disease?

• A break in superficial epithelial cells penetrating down into muscularis mucosa of either stomach or duodenum

24

Where are duodenal ulcers usually found?

• In duodenal cap

25

Where are gastric ulcers usually found?

Lesser curvature of the stomach

26

Why are gastric ulcers usually found in less curvature of the stomach?

• More contact with irritants
• More exposure to ulcerogenic refluxed acid

27

What is a peptic ulcer?

• Gastric ulcers are exclusively stomach related
Peptic ulcers can be stomach related, but are predominantly duodenal

28

Give the two leading causes of peptic ulcers in the developed world

• H pylori
• NSAIDS

29

How do non-steroidal anti-inflammatory drugs cause peptic ulcers?

• Inhibits cox-1, enzyme response for conversion of arachidonic acid to prostaglandin
• Prostaglandins produce protective unstirred layer of mucus This is lost with NSAID use

30

What % of patients have duodenal ulcers at somepoint in their lives?

15%

31

How many times more common are duodenal ulcers than gastric?

• 4:1 times

32

Give general symptoms of peptic ulcers

• Recurrent, burning epigastric pain
• Nausea
• Vomiting

33

How does the diagnosis of duodenal ulcers differ from gastric?

• Duodenal ulcers - Pain worse at night and when hungry, relieved by eating
• Gastric ulcers - Pain caused by eating food

34

What can occur after a long period of time with a gastric ulcer

• Ulcer can perforate blood vessels, causing haematamesis (vomiting of blood)

35

What can the clinical features of gastric ulcers be confused for?

• Gastric carcinoma

36

Outline three investigations for suspected peptic ulcers

• Investigate H. Pylori
• Endoscopy
• Barium meal

37

What is the management of peptic ulcer disease?

• If due to H pyloiri infection, triple therapy

Review NSAID use

38

What is a major complication of peptic ulcer disease?

• Iron defiency anaemia due to acute GI bleed
• Haematmesis and melena
• Perforation into peritoneal cavity

Gastric outlet obstruction

39

Where can a gastric obstruction be present?

Where can a gastric obstruction be present?
• Pre-pyloric, pyloric or duodenal

40

What is gastric obstruction as a result of peptic ulcer due to?

• Oedema with active ulcer

Fibrosis of ulcer

41

What does persistent penetrating pain from peptic ulcer indicate?

• Penetration of ulcer to other organs

42

What is H pylori?

• Bacteria - Gram negative
• Motile, aerobic
• Urease producing
• Adheres to gastric mucosa
• Produces cytotoxins
• Strong association with gastritis

43

How do H pylori survive the acidic conditions of the stomach?

• Production of urease produces ammonia, which neutralises acidic environment which allows bacterium to survive

44

How is H pylori diagnosed?

• IgG detected in serum (good sensitivity and specificity)
• 13C-urea breath test
• Gastric sample by endoscopy and detect by histology and culture

45

What is the 13Curea-breath test?

• 13Curea ingested - If H.pylori present the urease produced will break down 13C-urea to NH3 and CO2
• Carbon 13 will be detected in CO2 on exhalation

46

Give one thing other than helicobacter pylori which causes gastric ulceration

• NSAIDS

47

Outline the treatment for Helicobacter pylori

• Triple therapy
○ PPI - omeprazole
○ Two antibiotics - Clarithomycin/amoxicillin
○ H2 anatagonist

48

How effective is standard eradication therapy of H. Pylori?

• 80-90% chance of eradication

49

Outline three diseases which H.pylori increase risk of

• Gastritis
• Peptic ulcer disease
• Gastric disease

50

What does chronic gastritis cause?

• Hypergastrinaemia due to gastrin release from astral G cells -> This increased acid production is usually asymptomatic, but can lead to duodenal ulceration

51

What factors are implicated in the development of duodenal ulcers in people with H.pylori

• Genetic predispositions, bacterial virulence, increased gastrin secretion and smoking

52

How does H. Pylori cause peptic ulcers?

• Causes elevated levels of gastrin due to G-cell hyperplasia, predisposing to gastric ulceration

Less HCO3- produced, lives in mucus

53

Give two ways in which acid secretion may be reduced by drugs

• H2 antagonists
PPI