4. Gastric Disease Flashcards
What is dyspepsia?
A complex of upper gastrointestinal tract symptoms which are typically present for 4 or more weeks, including upper abdominal discomfort, heartburn, acid reflux, nausea and/or vomiting
What are the symptoms of gastro-oesophageal reflux disease (GORD)?
Heart burn
Acidic taste
Cough
Asymptomatic
What are risk factors for GORD?
Increased intraabdominal pressure Obesity Pregnancy LOS dysfunction Hiatus hernia Delayed gastric emptying
What is a hiatus hernia?
LOS herniates through diaphragm and ends up in the thorax
What is the LOS mechanism?
Normally contracted, only relaxes when bolus moves down oesophagus
Muscular elements - intrinsic and diaphragm
Right crus of diaphragm loops round lumen and can close it off
Angle that oesophagus joins stomach prevents reflux
Complications of GORD?
Oesophagitis Ulceration Haemorrhage Strictures - scar tissue Metaplastic changes - Barretts oesophagus
What is Barrett’s oesophagus?
Reversible change of stratified squamous epithelia to columnar because of repeated exposure to gastric contents
Leads to increased risk of dysphasia which can lead to adenocarcinoma
Management of GORD?
Lifestyle - weight loss, avoid trigger foods, eat smaller meals, don’t eat then sleep, decreased alcohol and caffeine, stop smoking
Drugs - proton pump inhibitors, H2 receptor antagonists
Surgery - fundoplication
What is gastritis?
Inflammation of the stomach mucosa
What can cause acute gastritis?
NSAIDs
Lots of alcohol
Chemotherapy
Bile reflux
What are causes for chronic gastritis?
Infection with H-pylori
Autoimmune
What pathological changes are present in acute gastritis?
Epithelial damage
Some epithelial hyperplasia
Vasodilation - ‘angry looking’
Neutrophil response
What pathological changes are present in chronic gastritis?
Lymphocyte response
Glandular atrophy
What happens in autoimmune causes of gastritis?
Antibodies to parietal cells
Lose parietal cells which decreases acid production and decreases intrinsic factor
Why are intrinsic factors important?
Increase absorption of vitamin B12
What are the symptoms of autoimmune gastritis?
Anaemia
Neurological symptoms
Anorexia - loss of appetite
Glossitis - inflammation of tongue
Why are H pylori bad in antrum of stomach?
G cells secrete more gastrin, stimulates parietal cells to secrete more acid and increases number of parietal cells
Too much acid produced, chyme more acidic
Damage to duodenum and conversion of duodenum epithelia to stomach epithelia
H pylori travels to duodenum which can cause duodenal ulcers
What impact does H pylori have on body of stomach?
Atrophy of parietal cells
Can be precursor for dysplastic changes
Increased risk of stomach cancer
How can H pylori be diagnosed?
Urea breath test
Stool antigen test
Endoscopy with biopsy
How does the urea breath test work?
Gastric urea is usually 99% C12 and 1% C13
Patients ingests urea C13 which, if H pylori is present, will be broken down into ammonia and CO2
CO2 with C13 will then be detected in the breath
How is H pylori treated?
Proton pump inhibitor and 2 antibiotics (clarithromycin and metronidazole) - 7 days usually
Test after treatment with urea breath test
What is the definition of peptic ulcer disease?
Defect in the gastric or duodenal mucosa that extends through the muscularis mucosa
Where is the most common place to find a peptic ulcer?
Duodenum
Lesser curve of stomach and antrum
What are the stomach defences?
Mucus layer HCO2 secretion Mucosal blood flow Prostaglandins Epithelial renewal
What are the risk factors for ulcers?
H-pylori
NSAIDs
Smoking
Massive physiological stress (e.g. burns)
How big are ulcers usually?
2cm
What is the base of the ulcer?
Necrotic tissue
Muscularis externa can be replaced by scar tissue
What is pyloric stenosis?
Scar tissue narrows lumen of stomach and can narrow pyloric sphincter
Can result in vomiting
What can ulcers lead to?
Peritonitis
Scar tissue formation
Bleeding into gut - causes malaena
Severe bleeding from gastro-duodenal artery into stomach/duodenum due to duodenal erosion
What are the symptoms of ulcers?
Epigastric pain -> back pain following meals
Pain at night (duodenal ulcers)
Resulting from bleeding - haematemesis, malaena
Early satiety
Weight loss
What is the management of peptic ulcer disease with no active bleeding?
H-pylori +ve - eradicate H-pylori, PPI, 2 antibiotics
H-pylori -ve - stop exacerbating medications, PPI
What is the management of peptic ulcer disease with bleeding?
Adrenaline injected and cauterise
Open surgery
