Week 5 - Gastric disease Flashcards Preview

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Flashcards in Week 5 - Gastric disease Deck (50):
1

What is GORD?

-Gastro-Oesophageal Reflux Disease
-Reflux of stomach contents into oesophagus

2

What are the symptoms of GORD?

-Heartburn, cough and wheeze, dysphagia, sore throat

3

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

4

Name 3 complications of GORD

-Oesophagitis
-Strictures
-Barretts Oesophagus

5

Why can oesopphagitis occur with GORD?

-Squamous cells of oesophagus intolerant to acid and inflammation occurs

6

What are the possible treatments of GORD?

-lifestyle modifications
-Antacids, H2 antagonists and PPIs

7

State some causes of acute gastritis

-Chronic NSAID use
-Chronic alcohol abuse
-Chemotherapy
-Bile reflux

8

How does acute gastritis present?

-Can be asymptomatic
-N+V
-Pain

9

State the common causes of chronic gastritis

-Bacterial infection with H.pylori
-Autoimmune -> antibody to parietal cells

10

How can autoimmune antibodies to parietal cells lead to pernicious anaemia?

-Destruction of parietal cells
-Decreased intrinsic factor
-Decreased vit b12 absorption
-Pernicious anaemia

11

What are the symptoms of chronic gastritis caused by H.pylori?

-Pain
-N+V

12

What are the symptoms of chronic gastritis caused by autoimmune?

-Anaemia, glossitis, anorexia
-Neurological symptoms such as gait and numbness

13

What is peptic ulcer disease?

-Eroision of gastric/duodenal mucosa which extends through the muscularis mucosa

14

Where is a peptic ulcer most common?

-Superior duodenum before bile duct entry

15

Where is a gastric ulcer most common?

-Lesser curvature

16

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

17

Do ulcers require treatment?

-They can be self-limiting or have drastic consequences

18

What are the symptoms of peptic/gastric ulcers?

-Burning epigastric pain following meals/ at night (peptic)
-Weight loss
-Bleeding or anaemia

19

Which arteries are most likely eroded in gastric and peptic ulcers?

-Gastric -> splenic
-Duodenal -> gastroduodnal

20

What is functional dyspepsia?

-Symptoms with no physical evidence of disease
-Should only be diagnosed when everything else ruled out

21

How is gastric pathology diagnosed?

-Endoscopy (with biopsy for H.pylori/cancer)
-Urease breath test (urease produced by H.pylori0
-CXR -> look for pneumoperitoneum

22

What is pneumoperitoneum?

-Air under diaphragm

23

How is H.pylori eradicated?

-PPi, Clarythromycin and amoxicillin

24

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

25

What can cause stress ulceration?

-Severe burns
-Raised ICP
-Sepsis
-Trauma/multiple organ failure

26

How is H.pylori spread?

-Feacal-oral
-Person-Person

27

What is the gram status of h.pylori?

-Helical, gram negative bacteria

28

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

29

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

30

Where is the most common place of colonisation in the stomach? What effect does colonisation have?

-Body
-Atrophic effect on parietal cells which decreases acid production and can lead to gastric ulcers

31

Where is colonisation with H.pylori least harmful?

-Antrum and body

32

At what stage in its course does stomach cancer present?

-Usually late

33

How does stomach cancer usually present?

-Dysphagia
-Loss of appetite
-Malaena
-Weightloss
-N+V
-Virchows nodes

34

Where are virchows nodes and what are they associated with?

-Above clavicle on LHS
-Stomach cancer

35

Where,geographically, have high rate of stomach cancer?

-Japan
-Chile

36

What are risk factors for stomach cancer?

-Male
-H.pylori
-Dietary factors
-Smoking

37

What is the main type of stomach cancer?

-Adenocarcinoma

38

Besides adenocarcinoma, name 3 types of stomach cancer

-Lymphoma
-Carcinoid
-Stromal

39

How is stomach cancer diagnosed?

-Bloods, CT, endoscopy

40

How is stomach cancer treated?

-Surgery, chemo, radiotherapy

41

Give an example of a problem with LOS leading to GORD

-Altered angle of entry
-Right crus of diaphragm not tight

42

Why can hiatus hernia lead to GORD?

-Reflux of contents is easier

43

What can cause bile reflux?

-Uncoordinated peristalsis in duodenum

44

What are the normal defence mechanisms which must be breached in order for a peptic ulcer to occur?

-Mucus
-Bicarbonate
-Adequate mucosal blood flow
-Prostaglandins
-Epithelial renewal

45

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

46

What does pneumoperitoneum indicate?

-Perforation

47

List some common disorders of the stomach

-GORD
-Gastritis
-Peptic Ulcer Disease
-Zollinger-ellison
-Stomach Cancer

48

How common is dyspepsia?

-40% UK pop per year

49

How common is stomach cancer?

-Third most common worldwide

50

How are ulcers treated?

-Antacids, H2 antagonist, PPIs
-Eradicate H.pylori
-Resection