Stomach pathology

Question 1

What does dyspepsia mean?

Answer 1

describes a complex of upper GI symptoms which present for 4 or more weeks

Question 2

What symptoms are included?

Answer 2

heart burn, coughing, sore throat (acid damages), dysphagia, nausea and vomiting

Question 3

What are some common gastric disorders?

Answer 3

GORD
Gastritis
Peptic ulcer disease
Zollinger-ellison disease
-Stress ulcers
-Cancer

Question 4

What is GORD?

Answer 4

where the stomach contents moves into the oesophagus

Question 5

What are the symptoms of GORD?

Answer 5

chest pain, acid taste in mouth, cough

Question 6

What are the consequences of GORD?

Answer 6

nothing

• oesophagitis
• strictures
• barrets oesophague (metaplasia of stratified squamous to simple columnar)

Question 7

What can trigger GORD?

Answer 7

• obesity (increased abdominal pressure)
• pregnancy (new or worsened cases)
• hiatus hernia (cardia of stomach moves into thorax reducing basal tone) HIGH RISK OF REFLUX OESOPHAGITIS
• LOS function
• delayed gastric emptying (increase in intra-gastric pressure)

Question 8

What does the LOS consist of?

Answer 8

• muscles
• right crus of diaphragm
• oblique entry of oesophagus into stomach
• intra abdominal pressure

Question 9

What is the treatment for GORD?

Answer 9

lifestyle modification (eat too fast/large meals/eat before bed)
pharmacological
-antacids (form layer of there acid)
-H2 antagonists (prevents histamine activating parietal cells)
-proton pump
surgery (RARE)

Question 10

What is gastritis?

Answer 10

inflammation of the stomach (can be acute or chronic)

Question 11

What are the of acute symptoms?

Answer 11

asymptomatic OR pain, nausea, vomiting, bleeding

-need to do endoscopy to see inflammation

Question 12

What causes acute gastritis?

Answer 12

• acute mucosal inflammatory processes
• heavy use of NSAIDs
• lots of alcohol
• chemotherapy
• bile reflux

Question 13

Why does chemical injury cause inflammation?

Answer 13

exposure of mucosa to chemical injury causes damages to epithelial cells so less mucus is produced and the mucose responds by vasodilation and appearance of inflammatory cells (neutrophils)

Question 14

What is the treatment for acute gastritis?

Answer 14

removal of the irritant

Question 15

What causes chronic gastritis?

Answer 15

• bacterial (H.pylori infection)

- autoimmune (antibodies to gastric parietal calles can lead to pernicious anaemia

Question 16

What is pernicious anaemia?

Answer 16

a deficiency in the production of RBC due to lack of vitamin D

Question 17

How does helicobacter-pylori cause inflammation?

Answer 17

• releases cytotoxins which directly injure the epithelia

- expresses enzymes that form urease causing ammonium production which is toxic (converts urea to ammonium)

Question 18

How can you get h-pylori?

Answer 18

spread via oral to oral transmission or faecal to oral speak - has a flagellum to aids in motility
-also lives in mucus layer and adores to the gastric epithelia

Question 19

What type of bacteria is h-pylori?

Answer 19

helix shaped

gram negative

Question 20

What symptoms does someone with chronic gastritis caused by bacteria cause?

Answer 20

• asymptomatic or similar to acute gastritis

- symptoms may develop due to complications (peptic ulcers, adenocarcinoma, MALT lymphoma)

Question 21

What occurs if H-pylori if found in the antrum (where G cells are) ?

Answer 21

there is increased gastrin secretion so increase parietal cell acid secretion - causes duodenal epithelial metaplasia and colonisation of duodenum causing a duodenal ulcer

Question 22

What occurs if H-pylori is found in the antrum and body?

Answer 22

asymtpomatic

Question 23

What occurs if H-pylori is found in the body?

Answer 23

-causes atrophy, gastric ulcer leading to intestinal metaplasia which can lead to dysplasia and then cancer

Question 24

How is H-pylori diagnosed?

Answer 24

• urea breath test

- stool antigen test

Question 25

How is H-pylori treated?

Answer 25

``` PPI Amoxicillin and (clarithromycin or metronidazole) ```

Question 26

What are the symptoms of autoimmune cause of chronic gastritis?

Answer 26

- anaemia symptoms - glossitis (inflammation of the tongue - anorexia - neurological symptoms

Question 27

What is peptic under disease?

Answer 27

occurs when there is a defect in the mucosa extending through the muscularis mucosa

Question 28

How does a peptic ulcer occur?

Answer 28

- mucosal injury like H-pylori and NSAIDs - smoking (only can contribute to relapse of ulcer disease) and stress like burns - caused by the breakdown of normal defences rather than excessive acid e.g. reduced gastric emptying and inadequate acid neutralisation

Question 29

Where is the most common place for peptic ulcers?

Answer 29

-most common in the first part of the duodenum but often affects the lesser curve/antrum of stomach

Question 30

What is the difference between acute and chronic peptic ulcer disease?

Answer 30

acute ulcers develop as part of acute gastritis but chronic ulcers occur most frequently at mucosal junction where the antrum meets the body

Question 31

What are the clinical consequences of peptic ulcer disease?

Answer 31

- scar tissue shrinking can narrow the stomach lumen - perforation can cause peritonitis - erosion can occur in to the adjacent structures (liver and pancreas) - Haemorrhage can occur from vessels in the base of the ulcer - malignancy is rare

Question 32

What are the symptoms of peptic ulcer disease?

Answer 32

-epigastric pain (as the stomach is a foregut structure) -burning following meal times -often at night SOME MORE SERIOUS SYMPTOMS -haematemesis or malaena(sticky dark faeces) -early satiety from repeated scarring -weight loss due to reluctance to eat due to pain

Question 33

How can you manage peptic ulcer disease?

Answer 33

- lifestyle modification - stopping any exacrerbating medications - testing for H-pylori - PPI's - endoscopy

Question 34

What is Zollinger-ellinson syndrome?

Answer 34

-non beta islet cell gastrin secreting tumour of the pancreas -causes proliferation of parietal cells (lots of acid production and severe ulceration of the stomach and small bowel)

Question 35

What are the symptoms of ZES?

Answer 35

- abdominal pain | - diarrhoea

Question 36

What is stress related mucosal damage?

Answer 36

ba broad term used to describe the spectrum of pathology attributed to the acute erosive, inflammatory insult to the upper GI tract associated with critical illness

Question 37

When can stress related mucosal damage occur?

Answer 37

- following multiple organ failure - sepsis - severe trauma - raised intracranial pressure - severe burns

Question 38

What are the symptoms of stomach cancer?

Answer 38

- usually presents late - has to be quite large before symptoms - dysphagia - loss of appeptie - malaena - weight loss - mausea/vomiting - virchovs nodes

Question 39

What are the risk factors for stomach cancer?

Answer 39

``` male h-pylori dietary factors smoking highest rates in japan/south America (they have screening programmes there) ```

Question 40

How is stomach pathology diagnosed?

Answer 40

- endoscopy (can take biopsy to look for bacteria and tumours - urease breath test (release by H-pylori - Chest x-ray will show if the bowel is perforated by air being seen - blood test to look for anaemia

Question 41

How can stomach pathology be treated?

Answer 41

- if caused by H-pylori, can give antibiotics - stop NSAISs - PPI - Histamine receptor (H2 blockers)