Stomach Disorders Flashcards by India Dodd

define peptic ulcers

ulceration of the either the gastric or duodenal mucosa that occurs either due to medications or H.Pylori infection

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which is more common, gastric or duodenal ulcers?

duodenal ulcers are more common

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name and define the 2 types of gastric ulcers

Type I - found in stomach and more likely to cause gastric bleed
Type II - found in pylorus and antrum

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risk factors for peptic ulcers

prolonged NSAID and/or steroid use
excessive alcohol intake
chronic stress/anxiety 
smoking 
high caffeine intake or spicy foods 
abnormal gastric emptying

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clinical features of peptic ulcers (no ulcer bleed)

epigastric pain 
heartburn 
dyspepsia 
nausea (sometimes with vomiting)
weight loss

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clinical features if ulcer bleeds in peptic ulcers

haematemesis
‘coffee ground’ vomiting
melaena

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what type of ulcer pain eases with food intake?

duodenal ulcers

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differentials of peptic ulcers

oesophagitis/gastritis 
GORD
malignancy 
biliary causes 
zollinger-ellison syndrome

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investigations of peptic ulcers (invasive)

upper GI endoscopy with rapid urease test (CLO) and maybe biopsy to exclude malignancy
bloods - FBC and IgG serum

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non-invasive investigations for peptic ulcers

urea breath test for H.Pylori presence

stool antigen test

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conservative management of peptic ulcers

advise to avoid NSAIDs
advise to cease smoking
advise to reduce/limit caffeine and alcohol intake

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medical management of peptic ulcers (H.Pylori cause)

7 days triple therapy of PPI, antibiotic and antacid

omezaprole
clarithromycin and amoxicillin

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medical management of peptic ulcers (non H.pylori)

4-8wk PPI trial for GORD symptoms

- H2 receptor antagonist (e.g. ranitidine) if PPI unsuccessful

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common complications of peptic ulcers

haemorrhage
perforation
gastric cancer
pyloric stenosis

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what type of bacterium is Helicobacter Pylori?

a gram -ve bacterium

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define gastroenteritis

a transient disorder that occurs due to enteric infection with virus, bacteria or parasites
- causes characteristic sudden onset of diarrhoea with/without vomiting

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name 3 common bacteria that cause gastroenteritis

clostridium perfringens
bacillus cereus
straphylococcus aureus

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clinical features of gastroenteritis

sudden-onset diarrhoea (>3x stools in 24hrs)
nausea or sudden-onset vomiting
fever/general malaise
abdominal pain or cramps

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risk factors of gastroenteritis

immunocompromised patients
poor personal hygiene
poor food hygiene
contact with infectious person/environment

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differentials of gastroenteritis

UTI
IBD
traveller’s diarrhoea
food-sensitivity

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investigations for gastroenteritis in certain circumstances

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stool sample (if patient immunocompromised and blood/mucus in stool)
bloods (FBC, U+E and RFTs) if unwell

management of gastroenteritis

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assess for dehydration and risk going forward
advise exclusion from work
only provide antibiotics if bacterial cause is known
take measures to prevent infection
food consumption should be guided by appetite

complications of gastroenteritis

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dehydration and electrolyte disturbance
Guilian-Barre Syndrome
haemolytic uraemia syndrome

define dyspepsia and its clinical features

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a discomfort/pain within the upper abdomen that presents with excessive flatulence, fullness/bloating, nausea and fatty food intolerance

what are red flag symptoms to look for in dyspepsia?

unintentional weight loss, recurrent vomiting, dysphagia and evidence of GI bleed

investigations for dyspepsia

abdominal examination to check for mass test for H.Pylori infection bloods - FBC, LFTs, RFTs, platelets

risk factors of dyspepsia

prolonged NSAID usage smoking excessive alcohol intake

conservative management of dyspepsia

offer advice on lifestyle modifications provide advice/refer for help with associated stress, anxiety or mood disorders consider stopping/reducing exacerbating drugs

medical management of dyspepsia and circumstance

if symptoms persist: | prescribe 1 month full-dose PPI OR retest for H.Pylori infection

when is endoscopy considered in suspected dyspepsia

if patient >55yrs, if symptoms persist, if raised platelet count, if vomiting/nausea or previous Barretts diagnosis

differentials of dyspepsia

``` peptic ulcer GORD (atypical) achlasia biliary pain pregnancy (in women) malignancy of oesophagus or stomach ```

management of dyspepsia in patients with no ALARM symptoms or need for investigation

review medications for possible cause offer lifestyle advice (e.g. weight loss, more frequent + smaller meals, avoid excess alcohol & smoking cessation) recommend OTC antacid use

define gastritis

inflammation of the mucosa of the stomach that occurs either due to infection, damage or erosion

causes of gastritis

``` H.Pylori infection prolonged NSAID use excessive alcohol consumption autoimmune disease major gastric surgery ```

risk factors of gastritis

H.pylori infection prolonged NSAID use critical illness alcohol abuse

clinical features of gastritis

``` epigastric pain nausea + vomiting loss of appetite MH of autoimmune disease PMH of gastric surgery ```

differentials of gastritis

peptic ulcer disease gastric cancer GORD

investigations of gastritis

urea breath test OR faecal antigen for H.Pylori | OGD endoscopy to visualise mucosa in elderly patients or those with ALARM symptoms

conservative management of gastritis

recommend avoidance of triggers (e.g. NSAIDS and alcohol)

medical management of gastritis

if H.Pylori cause: - eradication triple therapy (PPI, antibiotic, antacid) other cause: - PPI or H2 receptor antagonist (if PPI unsuccessful)

when is surgery indicated in gastritis?

if gastritis due to acid or biliary reflux due to previous surgery

common complications of gastritis

gastric cancer peptic ulcer disease vitamin B12 deficiency

most common form of gastric cancer

adenocarcinoma due to tumour suppressor gene p53

risk factors of gastric cancer

``` increasing age male sex smoking PMH of h.pylori infection poor diet and/or obesity PFH of gastric cancer ```

clinical features of gastric cancer

``` dyspepsia weight loss vomiting + nausea dysphagia anaemia ```

differentials of gastric cancer

IBS IBD achlasia barrett's

investigations for gastric cancer

bloods - FBC and LFTs CT abdomen + pelvis OGD with biopsy

management of gastric cancer

screen for nutritional deficiency and consider support | control symptoms of pain, nausea, constipation etc

what is treatment of choice for gastric cancer?

surgery - either gastrectomy or lymphadenocetomy

common complications of gastric cancer

metastasis | death

Stomach Disorders Flashcards

(50 cards)