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Stomach Flashcards

(45 cards)

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1
Q

What’s the most common type of gastric cancer?

A

Adenocarcinoma

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2
Q

Name 4 risk factors for gastric cancers

A 
H. Pylori infection 
Alcohol
Smoking
High nitrate food 
Low socioeconomic status 
Atrophic gastritis 
Ulcers , GORD
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3
Q

What type of anaemia can be seen with gastric cancer ?

A

Chronic iron deficiency anaemia

Or

Pernicious anaemia 
( complication ) due to autoimmune distraction of parietal cell causing lack of intrinsic factor and therefor lack of B12
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4
Q

What’s the gastric outlet syndrome ?

What can be heard on auscultation?

A 
Obstruction of gastric outlet leading to post Prandial vomiting ( non- billious ) early satiety, progressive dilatation of stomach, weight loss 
Metabolic acidosis ( hypokalaemia , hypochloraemic )
On auscultation : succussion splash
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5
Q

Name common symptoms a gastric carcinoma may present with

A 
Often asymptomatic until late 
Dyspepsia 
Nausea, vomiting
Post prandial full was
Anaemia 
Abdominal pain 
Weight loss 
Gastric outlet syndrome
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6
Q

Which 2 lymph nodes would be enlarged in a patient with gastric cancer?

A 
Virchows node ( left supraclavicular, thoracic duct joins subclavian vein )
Sister Mary Jospehs node (periumbilical )
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7
Q

Describe the dumping syndrome - when does it occur ?

A

Occurs after gastrectomy

Post prandial hypoglycaemia , decreases consciousness

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8
Q

Name 3 complications of gastric cancer and it’s treatment .

A

Post gastrectomy: maldigestion, dumping syndrome , small intestine bacterial overgrowth

Acanthosis nigrans

Pernicious anaemia

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9
Q

Which paraneoplastic skin addition is associated with gastric adenocarcinoma ?

A

Acanthosis nigrans
Velvet patches in axilla , neck , genital area ,
Itching

Other causes :
DM, Cushing , obesity , PCOS

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10
Q

What is a Gastrinoma?

A

Also called Zollinger- Ellison Syndrome

A gastrin secreting neuroendocrine tumour of either duodenum or pancreas
–> increased gastric acid production

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11
Q

How may zollinger ellison syndrome present ?

A

Recurrent , therapy resistant gastric ulcers

Diarrhoea
Steatorrhea

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12
Q

Name a primary gastric lymphoma

A

MALT lymphoma
Mucosa- associated lymphoid tissue lymphoma

B cell, non-Hodgkin

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13
Q

What’s a gastric MALT lymphoma strongly associated with ?

A

H pylori

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14
Q

Name 4 cells of the stomach and their function

A

Parietal cell
- acid and intrinsic factor secretion

Mucosal cell
-protective mucous secretion

Chief cell
- pepsinogen -> proteolysis
G- cells
Gastrin

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15
Q

What is dyspepsia ? Give 3 causes

A

Heartburn , indigestion
Features like

Early satiation
Postprandial fullness
Epigastric pain

Causes 
Peptic ulcer
GORD
Functional 
Gastric cancer
Myocardial infarction
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16
Q

What are the two
Most common causes of peptic
Ulcer ?

A

NSAIDs

H pylori

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17
Q

Name risk factors for peptic ulcer disease

A

Smoking
Stress
Alcohol
Zollinger Ellison syndrome

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18
Q

How to differentiate between a gastric or duodenal ulcer , solely by the patients history ?

What are typical locations for these ulcers ?

A 
Gastric ulcer
Pain with eating
Weight loss 
Appetite loss 
Anaemia
--> Antrum and lesser curvature 
Duodenal ulcer 
Weight gain
Pain when hungry or after eating 
Relieved with milk, food 
--> duodenal bulb
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19
Q

Name the 6 alarm symptoms in a patient with suspected ulcer that results in more invasive investigation such as gastroscopy?

Study These Flashcards
A 
Anaemia 
Loss of weight
Anorexia 
Recent onset / fast progression 
Melaena
Swallowing difficulty
20
Q

H. Pylori is a common cause of peptic ulcers . What is it and how does it induce inflammation?

Study These Flashcards
A

Gram - bacteria
Produces ammonia by urease enzyme which raises pH and allows growth

Infection results in
Antral gastritis
Ulcers
Gastric cancer or MALT lymphoma

21
Q

If suspected h pylori infection , which investigation would you do?

Study These Flashcards
A

Serology IgG
C urea breath test ( quick screening test )
Gastroscopy and urease test

22
Q

How would you treat a peptic ulcer caused by h pylori ?

Study These Flashcards
A

Triple therapy
PPI
Amoxicillin
Clarithromycin / metronidazole

In
Penicillin allergy
Clarithromycin and metronidazole

23
Q

Name 3 complications of peptic ulcers

Study These Flashcards
A 
Bleeding
Perforation 
Sub-hepatic abscess
Malignancy 
Gastric outlet obstruction
24
Q

What supportive measures can be performed in peptic ulcer disease ?
How to treat a h pylori negative patient ?

Study These Flashcards
A

Stop NSAIDs, smoking, alcohol, avoid stress

-PPI
-h2 Blocker
Antacids

25
What is menetriers disease ?
Giant gastric mucosal folds with atrophy, mucosal thickening , loss of protein -> low albumin and oedema Causes by h pylori and CMV
26
Name causes / risk factors of gastritis
``` H pylori NSAIDs Alcohol Hiatus hernia Crohns Sarcoidosis Zollinger Ellison Menetriers disease ```
27
What is type A gastritis ? Type B? Type C?
A : autoimmune - HLA-B8 und HLA-DR3 B bacterial eh h pylori C chemical e.g. NSAIDs and alcohol
28
Which form of anaemia can result from atrophic gastritis ?
Pernicious anaemia -> B12 deficiency ( lack Of intrinsic factor by parietal cell )
29
In gastritis , when to perform gastroscopy ?
Alarm symptoms | Persistent and treatment resistant with dysphagia or >55
30
What is GORD and what is it caused by?
Reflux of gastric contents that causes symptoms, injury or complications. Incompetent LOS Hiatus hernia Dysmobility of oesophagus Pregnancy Obesity Large meals
31
Name common symptoms | Of GORD
``` Heartburn Belching Increased watering Acid brash Chronic cough Laryngitis ```
32
What's achalasia ?
Aperistalsis of oesophagus , impaired relaxation of LOS
33
In GORD | What are treatment options?
Weight loss, smoking cessation , avoid citrus fruits, alcohol, hot drinks , onions , caffeine , spices , NSAIDs Lift bed up, avoid eating before bed Anatacids PPI H2 antagonists Gaviscon Fundoplication Magnetic bead band
34
What are Schatzki rings ?
B- rings , stricture , at gastric junction , accompanied by hiatus hernia
35
What are common complications of GORD?
Barrets oesophagus Aspiration Peptic ulcers , bleeding , anaemia Oesophageal rings (schatzki)
36
What happens in barrets oesophagus ? | How to treat it?
Reflux oesophagitis leads to metaplasia Squamous epithelial replaced by columnar + goblet cells PPI +/- mucosal resection
37
A patient presents with vomiting large volume of fresh blood. He is haemodynamically compromised . What is a likely diagnosis ?
Bleeding from gastric oesophageal varices
38
A patient with a history of GORD presents with small volume haematemesis . What's a likely diagnosis ?
Oesophagitis as cause for his GI bleed
39
A patient presents with haematemesis after continuous projectile vomiting . What's a likely diagnosis ?
Mallory Weiss tear
40
What's the most common cause of upper GI bleed?
Peptic ulcer bleeding | Common site : duodenal ulcer
41
A 54 year old male presents with iron deficiency anaemia . Which cause do you have to rule out?
Cancer of GI tract , chronic bleed
42
A 60 year old patient presents with rectal bleeding, BP of 90/60 and pulse of 115 bpm. He is unwell and pallor. What are your first steps of the management ?
Take blood for group and safe --> blood transfusion Large cannula Fluids Stop drugs like NSAIDs, aspirin, clopidogrel , warfarin Oxygen Urgent endoscopy This patient is in shock
43
A young male patient complains of constipation a rectal bleeding. He describes small amounts of bright red blood Post defecation . What's a likely cause ?
Anal fissure | Haemorrhoids
44
A 35 year old patient presents with bright red rectal bleeding . In his passed he had several perianal abscesses and fistula. He complains of diarrhoea . What's a diagnosis ?
Crohns
45
A young patient presents with weight loss, diarrhoea with bright red bleeding and occasionally mucous in his stools . What's a diagnosis to consider ?
Ulcerative colitis | Consider cancer

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