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Gastroentrology > 2: Peptic Ulcers, Gastric Carcinoma > Flashcards

2: Peptic Ulcers, Gastric Carcinoma Flashcards

1
Q

What is a peptic ulcer

A

break in lining of GI tract that extends to mucosa

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2
Q

where are peptic ulcers more common

A
  • Lesser stomach

- Duodenum

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3
Q

are gastric ulcers or duodenal ulcers more common

A

Duodenal

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4
Q

If H.pylori cause more duodenal or gastric ulcers

A

Duodenal (90%)

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5
Q

What percentage of duodenal ulcers are caused by H.pylori

A

90%

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6
Q

What percentage of gastric ulcers are caused by H.pylori

A

70%

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7
Q

aside from H. pylori what is a common cause of gastric ulcers

A

NSAIDs

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8
Q

what are three medications that can lead to peptic ulcers

A

NSAIDs
Glucocorticoids
SSRIs

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9
Q

by how much do NSAIDs increase the risk of peptic ulcers

A

5-times

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10
Q

by how much do glucocorticoids and NSAIDs increase risk of peptic ulcers

A

15-times

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11
Q

what are 6 other risk factors for peptic ulcers

A
  • Smoking
  • Alcohol
  • Age >65
  • Stress
  • Hyperparathyroidism
  • Zollinger-Ellison
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12
Q

What is Zollinger-Ellison syndrome

A

hyper-secretion of gastrin usually secondary to gastrinoma

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13
Q

What are 30% of ZE cases associated with

A

MEN-1

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14
Q

How does ZE usually present

A
  • Severe peptic ulcer disease
  • Malabsorption
  • Diarrhoea
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15
Q

What is the main investigation for Zollinger-Ellison syndrome

A

Fasting gastrin-levels

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16
Q

What proportion of peptic ulcers are asymptomatic

A

70%

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17
Q

Peptic ulcers can present with dyspepsia, what are 3 symptoms of dyspepsia

A
  1. Post-prandial epigastric pain
  2. Early satiety
  3. Relieved by antacids
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18
Q

in a gastric ulcer when does epigastric pain occur

A

Immediately after eating

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19
Q

what may epigastric pain immediately after eating lead to

A

Pain after eating leads to avoidance of food. This can lead to anorexia and weight loss.

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20
Q

what proportion of patients with gastric ulcers will have nocturnal pain

A

30-40

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21
Q

explain pain with duodenal ulcers

A

Pain occurs on an empty stomach and is relieved by eating

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22
Q

explain epigastric pain with duodenal ulcers

A

Pain may occur 2-5h post-feed

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23
Q

will there be weight loss or gain in duodenal ulcers and why

A

Weight gain - as eating relieve symptoms

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24
Q

what proportion of patients with duodenal ulcers experience nocturnal pain

A

50-80

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25
Q

When does epigastric pain occur in the following

a. Duodenal ulcers
b. Gastric ulcers

A

a. Empty stomach

b. Post-Feed

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26
Q

Explain weight-changes in the following

a. Duodenal ulcers
b. Gastric ulcers

A

a. weight gain

b. weight loss

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27
Q

What are 3 criteria for immediate referral for OGD

A
  1. Dysphagia
  2. > 55 with: dyspepsia, abdominal pain, weight loss and reflux
  3. New-onset dyspepsia resistant to PPIs
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28
Q

What protects the gastric mucosa

A

Bicarbonate secretion and gastric mucus

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29
Q

If a >55y has dysphagia or ALARMS symptoms what should be done

A

OGD

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30
Q

If not <55 or does not have dyspepsia what is first-line

A
  • Medication review and lifestyle advice

- Trial antacids for 4W

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31
Q

If individuals symptoms does not improve following 4W antacids what is performed

A

Test for H. pylori

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32
Q

If H.pylori test is negative, what should be done

A

Trial ranitidine or PPI for 4W

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33
Q

If 4W ranitidine or PPI are ineffective what is done

A

OGD and low-dose treatment

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34
Q

If H.pylori is positive what is done

A

Treat for H.pylori then review in 4W with Carbon-13-urea-breath test

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35
Q

What methods of investigation are most commonly used for H.pylori

A

Urea breath test

Stool antigen test

36
Q

Explain the carbon-13-urea breath test

A

Individual has drink containing C13 urea. If H.pylori is present urease will degrade this. 30-minutes later individual blows into mass-spec machine and detects amount of C13

37
Q

How many weeks should individual be off antibacterial treatment before performing carbon-13-urea-breath test

A

4W

38
Q

How many weeks should individual be off PPI treatment before performing carbon-13-urea-breath test

A

2W

39
Q

What is CLO testing

A

Sample form OGD biopsy is taken and mixed with pH indicator.

40
Q

What is the problem with serum antibody testing for H.pylori

A

Antibodies are raised even after treatment

41
Q

What are 4 pieces of lifestyle advice for H.pylori

A
  1. Reduce alcohol
  2. Smoking cessation
  3. Medication review: avoid NSAIDs
  4. Weight Loss
42
Q

What is a mnemonic to remember treatment of H.pylori

A

PAC

43
Q

What is given to treat H.Pylori

A

Ppi
Amoxicillin
Clarithromycin/Metronidazole

44
Q

If individuals are penicillin allergic, how is H.Pylori managed

A

Clarithromycin and Metronidazole

45
Q

What is the most common complication of peptic ulcer infection

A

Bleeding

46
Q

Which type of peptic ulcers are most likely to bleed and why

A

Posterior duodenal ulcers due to close proximity to gasproduodenal artery

47
Q

Which gastric ulcers are most likely to perforate

A

Anterior duodenal ulcers

48
Q

How will a perforated gastric ulcer present clinically

A

Sudden stabbing abdominal pain followed by diffuse generalised pain (peritonitis)

49
Q

Where may pain from perforated anterior duodenal ulcer be referred to

A

Shoulder tip

50
Q

Aside from bleeding and perforation what is a mother complication of peptic ulcers

A

Gastric outlet obstruction

51
Q

How will gastric outlet obstruction present

A
  • Succession splash
  • Post-prandial vomiting
  • Early satiety
52
Q

What is a gastric carcinoma

A

neoplasm of the stomach

53
Q

What is the global prevalence of gastric carcinoma

A

5th most common cancer

54
Q

In which gender are gastric carcinomas more common

A

Male (2:1)

55
Q

In which part of the country are gastric carcinomas more common

A

Korea

Japan

56
Q

What is the main risk factor for gastric adenocarcinoma

A

H.Pylori!

57
Q

What are 5 RF for gastric adenocarcinoma

A 
FH
Smoking
Nitrite-rich diet 
Blood Group A
Age
58
Q

Why are gastric adenocarcinomas typically detected late

A

Asymptomatic or non-specific symptoms

59
Q

What are 4 presenting symptoms of gastric carcinoma

A
  1. New-onset, treatment resistant dyspepsia
  2. Dysphagia
  3. Early satiety
  4. Weight Loss
  5. Vomiting
  6. Melena
  7. Anaemia
60
Q

What are 3 late stages of gastric carcinoma

A

Epigastric Mass
Trossier’s sign
Gastric outlet obstruction

61
Q

What is trossier’s sign

A

Palpable virchow’s node (left supraclavicular node)

62
Q

What is the most common type of gastric carcinoma

A

adenocarcinoma

63
Q

Are gastric adenocarcinomas diffuse or localised

A

localised growth

64
Q

What cells does gastric adenocarcinomas arise from

A

columnar epithelium

65
Q

Describe growth of signet ring carcinoma

A

diffuse growth

66
Q

How can signet ring cells be identified

A

large vacuole that displaces nucleus to one-side

67
Q

What is first-line investigation for suspected gastric adenocarcinoma

A

OGD and biopsy

68
Q

What three things should gastric adenocarcinoma biopsies be sent for

A
  1. Campylobacter-Like Organism (CLO) Testing
  2. Histology
  3. HER2 testing
69
Q

What system is used to stage gastric adenocarcinomas

A

TNM

70
Q

What two investigations are offered to all individuals with gastric adenocarcinoma to stage disease

A

CT CAP

Staging laparoscopy

71
Q

When is F18-FDG-PET-CT offered in gastric adenocarcinoma

A

Metastatic disease

72
Q

What should all patients with gastric adenocarcinoma receive

A

MDT meeting and nutritional support

73
Q

If a proximal gastric cancer - how is it managed

A

Total gastrectomy

74
Q

what is the criteria for total gastrectomy for gastric cancers

A

Must be less than 5cm from the gastro-oesophageal junction

75
Q

how is the GI tract reconstructed following total gastrectomy

A

Roux-En-Y-Reconstruction

76
Q

Explain a Roux-En-Y-Reconstruction

A

The proximal jejunum and duodenum are separated. Jejunum is attached to stomach giving a gastrojejunostomy

77
Q

What is classed as a distal gastric adenocarcinoma

A

antrum or pylorus

78
Q

how are distal gastric adenocarcinomas managed

A

subtotal gastrectomy

79
Q

how may patients with T1 gastric adenocarcinomas - confined to mucosa- be managed

A

endoscopic mucosal resection (EMR)

80
Q

in additional to gastrectomy what will patients receive

A

Neo-adjuvant and adjuvant chemotherapy

81
Q

if gastric adenocarcinoma is HER2 positive what is offered

A

tratsumab

82
Q

what are majority of patients with gastric adenocarcinoma offered and why

A

palliative approach due to presenting late

83
Q

what does a palliative approach for gastric adenocarcinoma involve

A

stenting + chemotherapy

84
Q

what is the 10-year survival rate of gastric adenocarcinoma

A

15%

85
Q

what are 4 possible complications of gastric ulcers

A
  • Gastric outlet obstruction
  • IDA
  • Perforation
  • Malnutrition
86
Q

what is a common complication of gastrectomy

A

vitamin B12 deficiency

Gastroentrology (18 decks)

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