Flashcards in Week 5 - Gastric disease Deck (50):
What is GORD?
-Gastro-Oesophageal Reflux Disease
-Reflux of stomach contents into oesophagus
What are the symptoms of GORD?
-Heartburn, cough and wheeze, dysphagia, sore throat
What are the causes of GORD?
-Lower Oesophageal sphincter problems
-Delayed gastric emptying causing increased intragastric pressure
-hiatus hernia = easier reflux
-Obesity -> increased intragastric pressure
Name 3 complications of GORD
Why can oesopphagitis occur with GORD?
-Squamous cells of oesophagus intolerant to acid and inflammation occurs
What are the possible treatments of GORD?
-Antacids, H2 antagonists and PPIs
State some causes of acute gastritis
-Chronic NSAID use
-Chronic alcohol abuse
How does acute gastritis present?
-Can be asymptomatic
State the common causes of chronic gastritis
-Bacterial infection with H.pylori
-Autoimmune -> antibody to parietal cells
How can autoimmune antibodies to parietal cells lead to pernicious anaemia?
-Destruction of parietal cells
-Decreased intrinsic factor
-Decreased vit b12 absorption
What are the symptoms of chronic gastritis caused by H.pylori?
What are the symptoms of chronic gastritis caused by autoimmune?
-Anaemia, glossitis, anorexia
-Neurological symptoms such as gait and numbness
What is peptic ulcer disease?
-Eroision of gastric/duodenal mucosa which extends through the muscularis mucosa
Where is a peptic ulcer most common?
-Superior duodenum before bile duct entry
Where is a gastric ulcer most common?
When does a peptic/gastric ulcer occur?
-When there is mucosal injury or a breach i defences eg caused by increased acid, NSAIDs or H.Pylori
Do ulcers require treatment?
-They can be self-limiting or have drastic consequences
What are the symptoms of peptic/gastric ulcers?
-Burning epigastric pain following meals/ at night (peptic)
-Bleeding or anaemia
Which arteries are most likely eroded in gastric and peptic ulcers?
-Gastric -> splenic
-Duodenal -> gastroduodnal
What is functional dyspepsia?
-Symptoms with no physical evidence of disease
-Should only be diagnosed when everything else ruled out
How is gastric pathology diagnosed?
-Endoscopy (with biopsy for H.pylori/cancer)
-Urease breath test (urease produced by H.pylori0
-CXR -> look for pneumoperitoneum
What is pneumoperitoneum?
-Air under diaphragm
How is H.pylori eradicated?
-PPi, Clarythromycin and amoxicillin
What is zollinger-ellison disease?
-Non-beta islet cell gastrin secreting tumour of pancreas causing proliferation of parietal cells increasing acid production and causing severe ulceration of stomach and duodenum
What can cause stress ulceration?
-Trauma/multiple organ failure
How is H.pylori spread?
What is the gram status of h.pylori?
-Helical, gram negative bacteria
What are the main virulence factors of H.pylori which allows it to survive in the stomach?
-Produces urease to convert urea to ammonium -> Increases local pH by producing an alkali cloud ->Protects from acid and disrupts epithelium by degrading mucus layer
-Uses chemotaxis to stay in alkali areas
-Has flagella for motility
-Releases cytotoxin for direct epithelial injury
How does H.pylori cause ulceration of duodenum?
-Colonisation in Antrum
-Stimulates G cells to produce gastrin-> increased HCL causing duodenal epithelium metaplasia due to production of acid chyme
-Colonisation of duodenal cap and duodenal ulceration
Where is the most common place of colonisation in the stomach? What effect does colonisation have?
-Atrophic effect on parietal cells which decreases acid production and can lead to gastric ulcers
Where is colonisation with H.pylori least harmful?
-Antrum and body
At what stage in its course does stomach cancer present?
How does stomach cancer usually present?
-Loss of appetite
Where are virchows nodes and what are they associated with?
-Above clavicle on LHS
Where,geographically, have high rate of stomach cancer?
What are risk factors for stomach cancer?
What is the main type of stomach cancer?
Besides adenocarcinoma, name 3 types of stomach cancer
How is stomach cancer diagnosed?
-Bloods, CT, endoscopy
How is stomach cancer treated?
-Surgery, chemo, radiotherapy
Give an example of a problem with LOS leading to GORD
-Altered angle of entry
-Right crus of diaphragm not tight
Why can hiatus hernia lead to GORD?
-Reflux of contents is easier
What can cause bile reflux?
-Uncoordinated peristalsis in duodenum
What are the normal defence mechanisms which must be breached in order for a peptic ulcer to occur?
-Adequate mucosal blood flow
Why does anaemia occur in peptic ulcer disease?
-Erousion through small blood vessel -> not big enough to cause haematemesis but enough to cause anaemia and malaena
What does pneumoperitoneum indicate?
List some common disorders of the stomach
-Peptic Ulcer Disease
How common is dyspepsia?
-40% UK pop per year
How common is stomach cancer?
-Third most common worldwide