8 Pathology of the Stomach Flashcards
Summary for reference:
What is dyspepsia?
Complex of upper gastrointestinal tract symptoms
(present for 4+ weeks)
- Upper abdominal pain/discomfort
- Heartburn
- Acid reflux
- Nausea
- Vomiting
What is GORD?
Gastro-oesopahgeal reflux disease
Acid from the stomach leaks up into the oesophagus
Give some examples of triggers/risk factors of GORD.
- Altered lower oesopahgeal sphincter function
- Delayed gastric emptying
- Obesity
- Pregnancy
- Hiatus hernia
- Older age
- Smoking
- Alcohol consumption
What can happen as a consequence of GORD? (3)
- Oesophagitis
- Strictures
- Barrett’s oesophagus
- Metaplasia of lower oesophageal epithelia
- Ulceration
- Haemorrhage (anaemia)
What is gastritis?
Inflammatory process in stomach’s mucosal layer
(Acute or chronic)
Identify 2 substances which can precipitate (ie cause/make worse) acute gastritis.
- NSAIDs
- Excessive alcohol consumption
- Chemotherapy
- Bile reflux
Identify 3 causes of chronic gastritis.
- H-pylori infection (most common)
-
Autoimmune cause (antibodies to gastric parietal cells)
- can lead to pernicious anaemia (B12 deficiency)
-
Chemical/reactive- minimal inflammation
- chronic alcohol abuse, NSAIDs, bile reflux
Explain how H-pylori is well adapted to the acidic environment of the stomach.
H-pylori= gram negative bacteria
Spread= oral to oral/ faecal to oral
Produces urease –> allows it to produce ammonium from urea in stomach- raises pH around bacteria
Flagellum- good motility and adheres to gastric epithelia
What effects does H-pylori have on the stomach?
- Damages epithelia of stomach
- Pro-inflammatory
What is peptic ulcer disease?
Breach in gastric or duodenal mucosa
Extends through muscularis mucosa
(Duodenal:stomach is 3:1 incidence)
Ulcers associated with:
- Use of NSAIDs
- H-pylori
- Effects of stomach acid
How is chronic ulcer disease treated?
Removing exacerbating factors
NSAIDs
Reducing acid
H-pylori
What is zollinger-ellison disease?
Endocrinopathy
Gastrin secreting tumours
Cause peptic ulcers - distal duodenum and proximal jejenum
Can be:
Sporadic (isolated)
Associated w./ Parathyroid and Pituitary tumours
There are 4 components of the lower oesophageal sphincter that facilitate its function. What are these 4 component?
When is the pressure in the lower oesophageal sphincter lowest and when is it highest?
Lowest: after meals
Highest: at night
How is GORD treated?
- Lifestyle modifications
- smaller meals, more often
- Don’t eat just before lying down
- Pharmacological
- PPIs
- H2 antagonists
- Antacids
- Surgery (rare)
Reflux oesophagitis and GORD can occur as a result of a hiatal hernia. Explain how:
Loss of pressure and basal tone
Loss of angle
Loss of diaphragmatic support
Explain how exposure of the mucosa to chemical injury can lead to acute gastritis.
Damaged epithelial cells
Reduced mucus production
–>Mucosa vasodilation/oedema–> inflammatory cells (neutrophils)
What symptoms might a patient with acute gastritis present with?
- Asymptomatic
- Abdominal pain, nausea, vomiting
- Occasional bleeding (v. serious)
How is acute gastritis treated?
Removal of irritant
What are the symptoms of chornic gastrtis caused by H-pylori?
- Asymptomatic
- Abdominal pain, nausea, vomiting
- Occasional bleeding (v. serious)
- Peptic ulcers
- Adenocarcinoma
- MALT lymphoma (mucosa-associated lymphoid tissue)
What are the symptoms of chronic gastritis caused by an autoimmune condition?
- Symptoms of anaemia
- Glossitis (inflammation of tongue)
- Anorexia- loss of appetite
- Neurological symptoms- B12 deficiency
Why is Helicobacter pylori found in the stomach and not lower down in the GI tract?
Not enough air further down
How will the symptoms vary if Helicobacter pylori colonises the following parts of the stomach:
- Antrum
- Antrum and body
- Body
- Antrum
- Duodenal ulceration
- Antrum and body
- Asymptomatic
- Body
- Metaplasia
How is a Helicobacter-pylori infection diagnoses and treated?
What is peptic ulcer disease?
Defects in gastric/duodenal mucosa
Extends through muscularis mucosa
Usually due to breakdown in normal defences eg: (Rather than excessive acid)
Mucus
Bicarbonate
Adequate mucosal blood flow
Prostaglandins
Epithelial removal
What are the most common sites for peptic ulcers?
- First part of duodenum
- Lesser curve/antrum of stomach
How does the prevalence of duodenal ulcers compare to gastric ulcers?
Give some causes of peptic ulcer disease:
Differentiate between acute and chronic peptic ulcer disease:
Describe the size and structure of a peptic ulcer
- Generally <2 cm but can be up to 10cm
- Base of ulcer= necrotic tissue/grranulation tissue
- Muscularis propria replaced w./scar tissue
Give some clinical consequences/complication of peptic ulcer disease
What are the symptoms of peptic ulcer disease?
How should peptic ulcer disease be managed?
What can the urease breath test be used to detect? Why might a blood test be carried out for peptic ulcer disease?
Urease breath test: to detect H.pylori
Blood test: FBC to detect anaemia (bleeding in GI tract)
What is Zollinger-Ellison syndrome?
What is stress related mucosal damage and give an example of a cause of it?
List some symptoms of stomach cancer:
What’s the difference between erosive and non-erosive GORD?
Whether or not changes can be seen on endoscopy
Give some of the symptoms of GORD.
Heart burn, cough, laryngitis, asthma, dental erosion (dysphagia)
