Stomach

Question 1

what is the definition of a hernia

Answer 1

protrusion of a whole or part of an organ through the wall of the cavity that contains it

Question 2

what is a hiatus hernia

Answer 2

protrusion of an organ (usually stomach) from the abdominal cavity into the thorax through the oesophageal hiatus

Question 3

what is the oesophageal hiatus

Answer 3

opening in the diaphragm through which the oesophagus and vagus nerve pass

Question 4

what are the 2 types of hiatus hernia

Answer 4

sliding hiatus hernia

rolling or para-oesophageal hernia

Question 5

risk factors for hiatus hernia

Answer 5

age related is the biggest factor - due to loss of diaphragmatic tone

pregnancy, obesity and ascites - all due to the raised intra-abdominal pressure and the superior displacement of the viscera

Question 6

clinical features of hiatus hernia

Answer 6

majority are completely asymptomatic

present with; gastroesophageal reflux symptoms (burning epigastric pain), vomiting and weight loss, bleeding/anaemia, hiccups or palpitations (irritation to diaphragm or pericardial sac), early satiety (if gastric outflow is blocked/narrowed)

Question 7

investigations into hiatus hernia

Answer 7

Oesophagogastroduodenoscopy (OGD) is the gold standard investigation

Question 8

management of hiatus hernias

Answer 8

conservative; PPIs (omeprazole), weight loss, alteration of diet (smaller meals), smoking and alcohol cessation - both inhibit LOS function

surgical; in those that remain symptomatic or show signs of gastric outlet obstruction, two types

Question 9

if there are symptoms of gastric outflow obstruction or weight loss whereby a GI malignancy may be suspected, what investigations should you do

Answer 9

urgent CT thorax and abdomen

Question 10

what branch of the aorta supplies the majority of the stomach

Answer 10

coeliac trunk

Question 11

what is the gold standard investigation to diagnose a hiatus hernia

Answer 11

OGD - oesophagogastroduodenoscopy

Question 12

what are the signs/symptoms of gastric volvulus

Answer 12

severe epigastric pain

retching without vomiting

inability to pass NG tube

Question 13

if a patient with a known large hiatus hernia presents with severe epigastric pain and retching without vomiting, what should you suspect

Answer 13

gastric volvulus

Question 14

by what mechanism are NSAIDs responsible for causing gastric ulceration

Answer 14

inhibition of prostaglandin secretion

Question 15

what is the definition of a peptic ulcer

Answer 15

its a break in the lining of the GI tract, extending through to the muscularis mucosae of the bowel wall

Question 16

where are gastric ulcers most commonly found

Answer 16

lesser curve of stomach or duodenum

Question 17

what are the 2 main causes of gastric ulcers

Answer 17

presence of H. pylori and prolonged use of NSAIDs

Question 18

whats the difference in symptoms between gastric and duodenal ulcers

Answer 18

gastric ulcers - pain is exacerbated by eating

duodenal - pain is worse 2-4 hours after eating

Question 19

clinical features of peptic ulcers

Answer 19

epigastric or retrosternal pain

nausea, bloating, early satiety

Question 20

investigations into peptic ulcers

Answer 20

first test for H. pylori - CLO test, urease breath test, stool antigen test

those with ongoing symptoms - OGD

biopsy and send for histology due to malignant potential

Question 21

what are the specific tests for H. pylori

Answer 21

CLO test - rapid urease test

stool antigen test

carbon-13 urea breath test

serum antibodies to H. pylori

Question 22

management of peptic ulcers

Answer 22

conservative; lifestyle advice - smoking cessation, weight loss, reduced alcohol, stop taking NSAIDs , PPIs

surgical; rare - only in cases of perforation, partial gastrectomy performed

Question 23

what is the most common type of gastric cancer

Answer 23

adenocarcinomas

Question 24

risk factors for H. pylori infection

Answer 24

male gender

increasing age

H. pylori infection

smoking

alcohol consumption

(very common in far eastern countries such as japan and korea)

Question 25

how does H. pylori cause stomach cancer

Answer 25

gram negative bacillus, that produces the urease enzyme which breaks down urea into CO2 and ammonia

the ammonia then neutralises the stomach acid, allowing the bacterium to create an alkaline microenvironment - allowing them to survive and reproduce

it then subsequently sets off a cycle of repeated damage to the epithelial cells, leading to inflammation, ulceration, and ultimately gastric neoplasia

Question 26

clinical features of gastric cancer

Answer 26

new onset dyspepsia (pain in the upper abdomen) , dysphagia (difficulty swallowing), early satiety, vomiting or malaena

non specific such as weight loss and anorexia are signs of late stage disease

Question 27

imaging and investigations into suspected gatric cancer

Answer 27

urgent bloods

urgent OGD - with subsequent biopsy taken

biopsy sent for; histology, CLO (H. pylori), HER2 expression (targeted monoclonal therapies)

for staging and planning treatment - CT chest-abdo-pelvis needed and staging laparoscopy

Question 28

what is the mainstay of management for gastric cancers

Answer 28

surgery with post-op chemo

usually a gastrectomy

Question 29

why is the 5 year survival rates of gastric cancer so low

Answer 29

most present at an advanced stage due to the vagueness of symptoms - most already metastasised

Question 30

what is Troisier’s sign of malignancy

Answer 30

an enlarged virchows node

Question 31

what is the main complication following gastrectomy

Answer 31

B12 deficiency