Stomach and Duodenal Pathology

Question 1

What are some of the causes of acute gastitis?

Answer 1

Chemical injury.
Severe burns.
Head injury.
Severe trauma and shock.

Question 2

Describe autoimmune chronic gastritis?

Answer 2

Quite rare.
Caused by anti-parietal and anti-intrinsic factor antibodies.
Casues atrophy and intestinal metaplasia in the body of the stomach.
Leads to increased risk of malignancy.

Question 3

Describe H. pylori infection, how it is spread, Where it is found in a human, how it affects the body and what it leads to an increased risk of?

Answer 3

H. pylori is a gram negative microaerophilic flagella Ted bacillus. Spread via Oral-oral/facial-oral spread It is found between the mucosa barrier and the epithelial cell surface keeping it away from the , it can be asymptomatic for a very long time. If symptomatic it is due to it causing higher secretion of IL8 which is involved with mediating inflammation of the stomach.
Increased risk of peptic ulcers (gastric ulcers and duodenal ulcers), gastric carcinoma and lypmhoma.

Question 4

Why do peptic ulcers occur?

Answer 4

Peptic ulcers occur due to a breach in the gastrointestinal mucosa due to H. Pylori/ NSAIDs, acid then causes the ulceration.

Question 5

What causes the protective layer of the stomach (mucus and bicarbonate secreted by the stomach mucosa) to be broken down?

Answer 5

Medications (NSAID’s and steroids).
H. Pylori.
Increased acid secretion due to stress, alcohol, smoking.

Question 6

How does eating help to determine whether epigastric pain is due to a gastric ulcer or a duodenal ulcer?

Answer 6

The epigastric pain is relived by eating if it is a duodenal ulcer as eating dilutes gastric acid and the pain will be increased by eating if it is a gastric ulcer.

Question 7

How are peptic ulcers diagnosed?

Answer 7

By endoscopy, during which a rapid urease test is done (CLO test) to diagnose the H. Pylori, a biopsy should maybe be done as well to check for cancer.

Question 8

What are the complications of a peptic ulcer?

Answer 8

Bleeding.
Perforation.
Scarring and strictures fo the muscle and mucosa that can lead to narrowing of the pylorus making it difficult to excrete contents from the stomach this is known as pyloric stenosis.

Question 9

How would a peptic ulcer present at a GP?

Answer 9

Epigastric discomfort or pain.
Vomiting/nausea.
Dyspepsia.
Anemia, due to all the bleeding within.

Question 10

What are the steps from a H. pylori infection to getting a gastric carcinoma?

Answer 10

H. pylori infection.
Chronic gastritis.
Intestinal metaplasia/atrophy.
Dysplasia.
Carcinoma.

Question 11

How would a cancer in this stomach spread?

Answer 11

Through lymph nodes.

Through the liver.

Question 12

What are the two major types of pathological variants of gastric cancer?

Answer 12

Intestinal and Diffuse.

Question 13

How would you confirm the diagnosis of a H. pylori infection?

Answer 13

Urea breath test.

Rapid urease test during endoscopy.

Question 14

What does H. pylori secrete into the epithelium that damages it?

Answer 14

It produces ammonia to neutralise the stomach acid, but this also directly affect the epithelium.

Question 15

How do you directly treat a H pylori infection?

Answer 15

Most common is triple therapy for one week:
PPI (like omeprazole).
2 antibiotics like amoxicillin and clarithromycin.

Also stop NSAIDs

Question 16

What are the causes of an upper GI bleed (bleeding in the oesophagus, stomach and the duodenum)?

Answer 16

Oesophageal varices.
Ulcers of the stomach or duodenum.
Cancers of the esophagus, stomach and duodenum.
Mallory-weiss tear (tear of the Oesophageal membrane most commonly at the gastro-oesophageal junction)).

Question 17

How would someone present with an upper GI bleed?

Answer 17

Haematemesis (vomiting blood).
‘Coffee ground vomit’ (vomiting digested blood that looks like coffee grounds.
Melaena (Tar like grease stools caused by digested blood.
In large blood loss, haemodynamic instability occurs so similar symptoms to shock, tachcardia and low blood pressure.
They may also have symptoms to do with the underlying pathology.

Question 18

What system is used to look at a person with a suspected upper GI bleed and what score indicates a high risk?

Answer 18

Glasgow-Blatchford score.

A score of >1.

Question 19

Name some of the things taken into account for the Glasgow-Blatchford score?

Answer 19

Drop in Hb.
Rise in Urea (due to blood being broken down in the GI tract, one of the products is urea which is absorbed in the intestines).
BP.
Recent Syncope.
Melanena.
Cardiac failure present.
Hepatic disease history
HR

Question 20

Describe the Rockall score?

Answer 20

It is used for people that have had an endoscopy and it gives a percentage risk score for rebleeding and morality.
It takes into account the findings from the presentation and an endoscopy like:
Age.
Cause of bleeding.
Co-morbitites.
Features of shock present.

Question 21

Describe how you would manage an upper GI bleed?

Answer 21

ABATED
ABCDE approach to resuscitation.
Bloods 
Access (2 large bore cannula).
Transfuse.
Endoscopy (within 24hrs).
Drugs (stop anticoagulants and NSAIDs

Question 22

What bloods would be ordered for someone who is having an upper GI bleed?

Answer 22

Haemoglobin (FBC).
Urea.
Coagulation (FBC for platlets).
Liver disease (LFTs).
Crossmatch 2 units of blood (Lab finds blood, tests to see if its compatible then has it ready in the fridge to be used if necessary.

Question 23

When treating an upper GI bleed transfusion is part of the management, what should you take into account when treating an upper GI bleed?

Answer 23

If massive haemorrage they should get blood, platelets and clotting factors.
If active bleeding make sure platlets are given.
Prothrombin complex concentrate should be given to patients taking warfarin that are actively bleeding.

Question 24

In an upper GI bleed, if someone has suspected oesophageal varices maybe due to a chronic liver disease what extra treatment should be given?

Answer 24

Terlipressin.

Prophylactic broad spectrum antibiotics.