Stomach and Duodenum

Question 1

What is Menetrier’s disease

Answer 1

A rare condition presenting with weight loss and diarrhoea

Question 2

What is Menetrier’s disease linked to

Answer 2

H pylori

Question 3

What can be seen endoscopically in Menetrier’s disease

Answer 3

Hypertrophy of mucosal folds of the body and fundus

Question 4

What is the treatment for Menetrier’s disease

Answer 4

To eradicate H pylori
Reduce recretion (PPIs) 
Monitor endoscopically due to risk of gastric cancer

Question 5

How are peptic ulcers caused

Answer 5

By an imbalance between luminal acid and mucosal defences

Question 6

How are peptic ulcers distinct from erosions

Answer 6

They penetrate the muscularis mucosae

Question 7

Are gastric ulcers usually benign or malifnant

Answer 7

Benign

Question 8

What are 3 main causes of gastric ulcers

Answer 8

H pylori and NSAID use
Steroid and NSAID use
Stress

Question 9

What are the clinical presentations of gastric ulcers

Answer 9

usually pain that is relieved on eating

Question 10

What are some complications of a gastric ulcer

Answer 10

Haematemesis

perforation are commoner in the elderly

Question 11

What are the clinical presentations of gastric ulcers

Answer 11

usually pain that comes on soon after eating

Question 12

What are some complications of a gastric ulcer

Answer 12

Haematemesis

perforation are commoner in the elderly

Question 13

What is the management for a peptic ulcer

Answer 13

Eradication of H pylori
4 weeks PPI
Smoking cessation and alcohol moderation
Stop NSAIDs if possible

Question 14

When should surgery be considered in gastric ulcers

Answer 14

If there is haemmorhage
perforation
failure to heal or gastric outlet obstruction

Question 15

What are the 4 main causes of a duodenal ulcer

Answer 15

H pylori
NSAID use
Smoking
Stress

Question 16

Is perforation as a complication more common in gastric or duodenal ulcers

Answer 16

Gastric

Question 17

What is the management of duodenal ulcers

Answer 17

Eradication of H pylori - routine use of PPI if there is haemorrhage
Smoking cessation
alcohol moderation
stop ulcerogenic drugs (NSAIDs and bisphosphonates)

Question 18

What is the mortality rate for perforated ulcers

Answer 18

25%

Question 19

What is the mortality rate for perforated ulcers

Answer 19

25%

Question 20

What is the initial management for gastric outlet obstruction

Answer 20

Drip and suck - IV rehydration and NG aspiration

Question 21

What is the later management for gastric outlet obstruction

Answer 21

Balloon dilatation or surgical resection

Question 22

What is Zollinger-Ellison syndrome

Answer 22

A rare disorder with the triad of:
severe or recurrent peptic ulceration
Increased gastric acid secretion
Hypergastrinaemia due to a secretion from a non-beta cell islet pancreatic tumour

Question 23

What often occurs with Zollinger-Ellison syndrome

Answer 23

Diarrhoea and steatorrhoea

Question 24

What are the investigations for Zollinger-Ellison syndrome

Answer 24

Gastric acid secretion elevated and serum gastrin elevated

Question 25

How is the cause investigated in Zollinger-Ellison syndrome

Answer 25

Endoscopic ultrasound or Oxtreoscan

Question 26

What is the management for Zollinger Ellison syndrome

Answer 26

30% resectable Lifelong PPI in high dose Octreotide may help

Question 27

What is gastroparesis

Answer 27

Delayed gastric emptying without mechanical obstruction

Question 28

What are some characteristic of gastroparesis

Answer 28

recurrent vomiting abdominal bloating distension

Question 29

What might help with gastroparesis

Answer 29

Peripherally acting antiemetics (domperidone)

Question 30

What is indicated if malnutrition develops

Answer 30

Jejunostomy or parenteral nutrition

Question 31

What is the most commonest cause of cancer death worldwide

Answer 31

Gastric carcinoma

Question 32

Who is more likely to get gastric carcinoma

Answer 32

Men and those over 50

Question 33

What are 6 causes of gastric carcinoma

Answer 33

Chronic H pylori infection Familial: blood group A is associated Genetic Diet containing pickled or smoked foods, diets low in fruit and veg Environment; smoking and alcohol Rare, organic disorders; Menetrier's disease and previous partial gastrectomy

Question 34

What does adenocarcinoma develope from

Answer 34

Regions of intestinal metaplasia in the stomach which then develop secondary to chronic atrophic gastritis

Question 35

What does early gastric cancer refer to

Answer 35

Adenocarcinoma confined to the mucosa or submucosa

Question 36

What does early gastric cancer refer to

Answer 36

Adenocarcinoma confined to the mucosa or submucosa

Question 37

What are the clincial features of gastric carcinoma

Answer 37

Epigastric pain Loss of appetite loss of weigh haematemesis is rare

Question 38

What is the investigation for the gastric carcinoma

Answer 38

Endoscopy - rolled irregular edged ulcers

Question 39

What are some of the investigations for the complications of gastric carcinoma

Answer 39

Staging: FBC, LFT, CXR, Abdo CT, endoscopic US, laparoscopy

Question 40

How is gastric cancer managed

Answer 40

Surgery: resection is only possible in a minority of cases and most surgery is palliative Chemotherapy: Post op may improve survival and can also be used palliatively

Question 41

How could prognosis of gastric cancer be improved

Answer 41

Public awareness and early diagnosis

Question 42

Where is the most commonest site for non-nodal non-Hodgkin's lymphoma

Answer 42

The stomach

Question 43

What is MALT lymphoma

Answer 43

A B cell tumour caused by an immune response to chronic H pylori infection with cagA strains

Question 44

Where do Gastrointestinal stromal tumours arise from

Answer 44

The interstitial cells of Cajal