Stomach diseases

Question 1

What is Gastroparesis

Answer 1

a motility disorder associated with delayed gastric emptying of solid food without mechanical obstruction

Question 2

What are the possible causes of Gastroparesis (6)

Answer 2

diabetes
Neurological conditions
Connective tissue conditions
Post-surgery
Medications
Idiopathic

Question 3

What are the symptoms of Gastroparesis (3)

Answer 3

upper abdominal pain
Postprandial fullness
Nausea and vomiting

Question 4

What investigations are used for Gastroparesis (2)

Answer 4

OGD
Gastric emptying studies

Question 5

What methods are used to treat gastroparesis (7)

Answer 5

dietary modifications
Glycemic control
Cessation of aggravating medications
Pro-kinetics
Neuromodulators
Gastric pacemaker
Venting gastronomy

Question 6

What does GORD refer to

Answer 6

a spectrum of diseases producing symptoms of heart burn and acid regurgitation due to retrograde movements of gastric contents from the stomach to the oesophagus

Question 7

What is the pathophysiology of GORD (4)

Answer 7

Anti reflux barriers decrease
Gastric acid secretion occurs
Duodenogastric reflux occurs
Gastric emptying is delayed

Question 8

What anti-reflux barriers normally exist (3)

Answer 8

lower oesophageal sphincter tone
Oesophageal acid clearance
Tissue resistance

Question 9

What are the risk factors for GORD (3 lifestyle 3 others)

Answer 9

Obesity
Smoking
Alcohol
Genetics
Hiatus hernia
Pregnancy

Question 10

How can GORD present

Answer 10

asymptomatic
Heart burn
Regurgitations
Odonyphagia
Burping, hiccups
Nausea/vomiting
Cough
Hoarseness
Chest pain

Question 11

What are signs of GORD (4)

Answer 11

haematemesis/Melaena
Dysphagia
Weight loss
Persistent vomiting

Question 12

What investigations can be used for GORD (2)

Answer 12

OGD
H/pylori breath test/stool antigen test

Question 13

What methods of treatment can be used for GORD (5)

Answer 13

Lifestyle modifications
Anti acids/alginates
PPI
H2 receptor antagonist
H.pylori eradication

Question 14

What is a significant complication that can arise due to GORD

Answer 14

barret’s oesophagus

Question 15

What are the types of chronic gastritis (3)

Answer 15

Autoimmune
H.pylori associated
Chemical

Question 16

Describe the changes that occur in autoimmune gastritis (4)

Answer 16

Loss of gastric parietal cells
Gastric atrophy
Intestinal Metaplasia
Inflammation

Question 17

What deficiencies is autoimmune gastritis associated with (2)

Answer 17

macrocytic anaemia
B12 deficiency

Question 18

What complications are linked with H.pylori associated gastritis

Answer 18

Ulceration
Atrophy
Intestinal Metaplasia
Gastric cancer
MALT lymphoma

Question 19

Describe chemical gastritis (3)

Answer 19

Injury to mucous layer by fat solvents
Leads to epithelial regeneration, hyperplasia, and congestions
Can lead to erosions and ulcers

Question 20

What can contribute to chemical gastritis (3)

Answer 20

NSAIDs
Alcohol
Bile reflux

Question 21

Which type of gastritis involves minimal inflammation

Answer 21

Chemical gastritis

Question 22

What is a peptic ulcer

Answer 22

a breach in mucosa due to injury by acid or pepsin

Question 23

How does H.pylori contribute to pathology of peptic ulcers

Answer 23

Increases gastric secretion > increased delivery of hydrogen ions to the duodenum
Reduces bicarbonate production if directly in the duodenum

Question 24

How do NSAIDs contribute to the pathology of peptic ulcers

Answer 24

inhibit COX1 and COX2
Decreases prostaglandin production
Increase risk of mucosal erosion

Question 25

What are common sites for peptic ulcers (4)

Answer 25

1st part of duodenum Junction between body and antrum of stomach Stomach near surgical connection or anastomosis Gastro-oesophageal junction

Question 26

What are complications of peptic ulcers (4)

Answer 26

perforation Haemorrhage Stenosis Pain

Question 27

What types of benign gastric tumours exist (2)

Answer 27

Hyperplastic polyps Cystic fundi gland polyps

Question 28

What types of malignant gastric tumour exist (3)

Answer 28

carcinomas (Adenocarcinoma) Lymphoma GIST

Question 29

Describe the aetiology of gastric Adenocarcinoma

Answer 29

H.pylori infection > chronic gastritis > gastric atrophy > intestinal Metaplasia > dysplasia > adenocarcinoma

Question 30

What are the types of gastric adenocarcinoma (4)

Answer 30

diffuse type Intestinal type Mixed Undifferentiated

Question 31

Describe diffuse type gastric adenocarcinoma

Answer 31

a tumour that infiltrates and expands the stomach wall rather than growing as a discrete tumour

Question 32

Describe gastric lymphomas

Answer 32

Continuous inflammation induces evolution into clonal B cell proliferation Can evolve into high grade B cell lymphoma if untreated

Question 33

Describe GIST tumours (2)

Answer 33

gastrointestinal stroma tumours derived from gut pacemaker cells

Question 34

What investigations are done for gastric tumours (4)

Answer 34

endoscopy CT chest abdomen and pelvis CT PET Laparoscopy

Question 35

What treatments are used for gastric tumours (3)

Answer 35

endoscopic resection (of mucosa/submucosa) Endoscopic-guided radiofrequency ablation Gastrectomy with D2 lymphadenectomy (subtotal/total)

Question 36

If a patient presents with 3weeks of fresh haematemesis and 3months of early satiety and Epigastric pain, what is the most likely diagnosis

Answer 36

gastric cancer