Week 5 - Gastric disease

Question 1

What is GORD?

Answer 1

• Gastro-Oesophageal Reflux Disease

- Reflux of stomach contents into oesophagus

Question 2

What are the symptoms of GORD?

Answer 2

-Heartburn, cough and wheeze, dysphagia, sore throat

Question 3

What are the causes of GORD?

Answer 3

• Lower Oesophageal sphincter problems
• Delayed gastric emptying causing increased intragastric pressure
• hiatus hernia = easier reflux
• Obesity -> increased intragastric pressure

Question 4

Name 3 complications of GORD

Answer 4

• Oesophagitis
• Strictures
• Barretts Oesophagus

Question 5

Why can oesopphagitis occur with GORD?

Answer 5

-Squamous cells of oesophagus intolerant to acid and inflammation occurs

Question 6

What are the possible treatments of GORD?

Answer 6

• lifestyle modifications

- Antacids, H2 antagonists and PPIs

Question 7

State some causes of acute gastritis

Answer 7

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

Question 8

How does acute gastritis present?

Answer 8

• Can be asymptomatic
• N+V
• Pain

Question 9

State the common causes of chronic gastritis

Answer 9

• Bacterial infection with H.pylori

- Autoimmune -> antibody to parietal cells

Question 10

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

Answer 10

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

Question 11

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

Answer 11

• Pain

- N+V

Question 12

What are the symptoms of chronic gastritis caused by autoimmune?

Answer 12

• Anaemia, glossitis, anorexia

- Neurological symptoms such as gait and numbness

Question 13

What is peptic ulcer disease?

Answer 13

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

Question 14

Where is a peptic ulcer most common?

Answer 14

-Superior duodenum before bile duct entry

Question 15

Where is a gastric ulcer most common?

Answer 15

-Lesser curvature

Question 16

When does a peptic/gastric ulcer occur?

Answer 16

-When there is mucosal injury or a breach i defences eg caused by increased acid, NSAIDs or H.Pylori

Question 17

Do ulcers require treatment?

Answer 17

-They can be self-limiting or have drastic consequences

Question 18

What are the symptoms of peptic/gastric ulcers?

Answer 18

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

Question 19

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

Answer 19

• Gastric -> splenic

- Duodenal -> gastroduodnal

Question 20

What is functional dyspepsia?

Answer 20

• Symptoms with no physical evidence of disease

- Should only be diagnosed when everything else ruled out

Question 21

How is gastric pathology diagnosed?

Answer 21

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

Question 22

What is pneumoperitoneum?

Answer 22

-Air under diaphragm

Question 23

How is H.pylori eradicated?

Answer 23

-PPi, Clarythromycin and amoxicillin

Question 24

What is zollinger-ellison disease?

Answer 24

-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

Question 25

What can cause stress ulceration?

Answer 25

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

Question 26

How is H.pylori spread?

Answer 26

- Feacal-oral | - Person-Person

Question 27

What is the gram status of h.pylori?

Answer 27

-Helical, gram negative bacteria

Question 28

What are the main virulence factors of H.pylori which allows it to survive in the stomach?

Answer 28

- 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

Question 29

How does H.pylori cause ulceration of duodenum?

Answer 29

- 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

Question 30

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

Answer 30

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

Question 31

Where is colonisation with H.pylori least harmful?

Answer 31

-Antrum and body

Question 32

At what stage in its course does stomach cancer present?

Answer 32

-Usually late

Question 33

How does stomach cancer usually present?

Answer 33

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

Question 34

Where are virchows nodes and what are they associated with?

Answer 34

- Above clavicle on LHS | - Stomach cancer

Question 35

Where,geographically, have high rate of stomach cancer?

Answer 35

- Japan | - Chile

Question 36

What are risk factors for stomach cancer?

Answer 36

- Male - H.pylori - Dietary factors - Smoking

Question 37

What is the main type of stomach cancer?

Answer 37

-Adenocarcinoma

Question 38

Besides adenocarcinoma, name 3 types of stomach cancer

Answer 38

- Lymphoma - Carcinoid - Stromal

Question 39

How is stomach cancer diagnosed?

Answer 39

-Bloods, CT, endoscopy

Question 40

How is stomach cancer treated?

Answer 40

-Surgery, chemo, radiotherapy

Question 41

Give an example of a problem with LOS leading to GORD

Answer 41

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

Question 42

Why can hiatus hernia lead to GORD?

Answer 42

-Reflux of contents is easier

Question 43

What can cause bile reflux?

Answer 43

-Uncoordinated peristalsis in duodenum

Question 44

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

Answer 44

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

Question 45

Why does anaemia occur in peptic ulcer disease?

Answer 45

-Erousion through small blood vessel -> not big enough to cause haematemesis but enough to cause anaemia and malaena

Question 46

What does pneumoperitoneum indicate?

Answer 46

-Perforation

Question 47

List some common disorders of the stomach

Answer 47

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

Question 48

How common is dyspepsia?

Answer 48

-40% UK pop per year

Question 49

How common is stomach cancer?

Answer 49

-Third most common worldwide

Question 50

How are ulcers treated?

Answer 50

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