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3 Gastrointestinal System > 8 Pathology of the Stomach > Flashcards

8 Pathology of the Stomach Flashcards

1
Q

Summary for reference:

A
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2
Q

What is dyspepsia?

A

Complex of upper gastrointestinal tract symptoms

(present for 4+ weeks)

  • Upper abdominal pain/discomfort
  • Heartburn
  • Acid reflux
  • Nausea
  • Vomiting
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3
Q

What is GORD?

A

Gastro-oesopahgeal reflux disease

Acid from the stomach leaks up into the oesophagus

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4
Q

Give some examples of triggers/risk factors of GORD.

A
  1. Altered lower oesopahgeal sphincter function
  2. Delayed gastric emptying
  3. Obesity
  4. Pregnancy
  5. Hiatus hernia
  6. Older age
  7. Smoking
  8. Alcohol consumption
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5
Q

What can happen as a consequence of GORD? (3)

A
  • Oesophagitis
  • Strictures
  • Barrett’s oesophagus
    • Metaplasia of lower oesophageal epithelia
  • Ulceration
  • Haemorrhage (anaemia)
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6
Q

What is gastritis?

A

Inflammatory process in stomach’s mucosal layer

(Acute or chronic)

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7
Q

Identify 2 substances which can precipitate (ie cause/make worse) acute gastritis.

A
  • NSAIDs
  • Excessive alcohol consumption
  • Chemotherapy
  • Bile reflux
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8
Q

Identify 3 causes of chronic gastritis.

A
  • 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
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9
Q

Explain how H-pylori is well adapted to the acidic environment of the stomach.

A

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

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10
Q

What effects does H-pylori have on the stomach?

A
  • Damages epithelia of stomach
  • Pro-inflammatory
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11
Q

What is peptic ulcer disease?

A

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
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12
Q

How is chronic ulcer disease treated?

A

Removing exacerbating factors

NSAIDs

Reducing acid

H-pylori

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13
Q

What is zollinger-ellison disease?

A

Endocrinopathy

Gastrin secreting tumours

Cause peptic ulcers - distal duodenum and proximal jejenum

Can be:

Sporadic (isolated)

Associated w./ Parathyroid and Pituitary tumours

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14
Q

There are 4 components of the lower oesophageal sphincter that facilitate its function. What are these 4 component?

A
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15
Q

When is the pressure in the lower oesophageal sphincter lowest and when is it highest?

A

Lowest: after meals

Highest: at night

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16
Q

How is GORD treated?

A
  • Lifestyle modifications
    • smaller meals, more often
    • Don’t eat just before lying down
  • Pharmacological
    • PPIs
    • H2 antagonists
    • Antacids
  • Surgery (rare)
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17
Q

Reflux oesophagitis and GORD can occur as a result of a hiatal hernia. Explain how:

A

Loss of pressure and basal tone

Loss of angle

Loss of diaphragmatic support

18
Q

Explain how exposure of the mucosa to chemical injury can lead to acute gastritis.

A

Damaged epithelial cells

Reduced mucus production

–>Mucosa vasodilation/oedema–> inflammatory cells (neutrophils)

19
Q

What symptoms might a patient with acute gastritis present with?

A
  • Asymptomatic
  • Abdominal pain, nausea, vomiting
  • Occasional bleeding (v. serious)
20
Q

How is acute gastritis treated?

A

Removal of irritant

21
Q

What are the symptoms of chornic gastrtis caused by H-pylori?

A
  • Asymptomatic
  • Abdominal pain, nausea, vomiting
  • Occasional bleeding (v. serious)
  • Peptic ulcers
  • Adenocarcinoma
  • MALT lymphoma (mucosa-associated lymphoid tissue)
22
Q

What are the symptoms of chronic gastritis caused by an autoimmune condition?

A
  • Symptoms of anaemia
  • Glossitis (inflammation of tongue)
  • Anorexia- loss of appetite
  • Neurological symptoms- B12 deficiency
23
Q

Why is Helicobacter pylori found in the stomach and not lower down in the GI tract?

A

Not enough air further down

24
Q

How will the symptoms vary if Helicobacter pylori colonises the following parts of the stomach:

  • Antrum
  • Antrum and body
  • Body
A
  • Antrum
    • Duodenal ulceration
  • Antrum and body
    • Asymptomatic
  • Body
    • Metaplasia
25
Q

How is a Helicobacter-pylori infection diagnoses and treated?

A
26
Q

What is peptic ulcer disease?

A

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

27
Q

What are the most common sites for peptic ulcers?

A
  1. First part of duodenum
  2. Lesser curve/antrum of stomach
28
Q

How does the prevalence of duodenal ulcers compare to gastric ulcers?

A
29
Q

Give some causes of peptic ulcer disease:

A
30
Q

Differentiate between acute and chronic peptic ulcer disease:

A
31
Q

Describe the size and structure of a peptic ulcer

A
  • Generally <2 cm but can be up to 10cm
  • Base of ulcer= necrotic tissue/grranulation tissue
  • Muscularis propria replaced w./scar tissue
32
Q

Give some clinical consequences/complication of peptic ulcer disease

A
33
Q

What are the symptoms of peptic ulcer disease?

A
34
Q

How should peptic ulcer disease be managed?

A
35
Q

What can the urease breath test be used to detect? Why might a blood test be carried out for peptic ulcer disease?

A

Urease breath test: to detect H.pylori

Blood test: FBC to detect anaemia (bleeding in GI tract)

36
Q

What is Zollinger-Ellison syndrome?

A
37
Q

What is stress related mucosal damage and give an example of a cause of it?

A
38
Q

List some symptoms of stomach cancer:

A
39
Q

What’s the difference between erosive and non-erosive GORD?

A

Whether or not changes can be seen on endoscopy

40
Q

Give some of the symptoms of GORD.

A

Heart burn, cough, laryngitis, asthma, dental erosion (dysphagia)

3 Gastrointestinal System (19 decks)

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