can u stomach this? Flashcards
what is a peptic ulcer
a breakdown of the mucosa in the stomach or duodenum
duodenal ulcers are more common
what can cause a peptic ulcer
H. pylori infection
medications - steroids, NSAIDS
increased acid production from stress, alcohol, caffeine, spicy food, smoking
hyperparathyroidism
how may a peptic ulcer present
epigastric pain/discomfort nausea vomiting dyspepsia regurgitation reflux haematemesis melaena anaemia epigastric tenderness backpain gastric ulcers worsen symptoms after eating, duodenal ulcer symptoms improve after eating
what investigations could you do for a gastric ulcer
endoscopy
urease test
biopsy
bloods - look for iron deficiency anaemia
how could you treat a peptic ulcer
PPIs
stop NSAIDS, steroids
treat h.pylori
antacids
what are complications of peptic ulcers
could cause an acute GI bleed
perforation - peritonitis - requires urgent surgery
the scar tissue from healing ulcers can cause pyloric strictures
chronic ulcers can cause iron deficiency anaemia
can cause malignancy
pyloric stenosis
what effect does H. pylori have on the GI system
the bacteria produces urease which then synthesises ammonia and breaks down the mucosa of the stomach/duodenum, it also neutralises the pH so it can live in the stomach for longer
how could H. pylori present
usually asymptomatic until an ulcer forms
fever
what tests could you do to diagnose a H.pylori infection
urea breath test
stool antigen test
rapid urease test during endoscopy
how could you treat h. pylori infection
triple therapy - PPI + 2 antibiotics
clarithromycin 500mg + amoxicillin 1g
clarithromycin 400mg + metronidazole 250mg
what is gastric cancer
adenocarcinoma of glandular epithelium in the stomach
2nd most common malignancy
what can cause gastric cancer
h. pylori
reflux
genetics - CDH-1 gene
what are risk factors for gastric cancer
alcohol smoking nitrogenous food diet genetics h. pylori
how may gastric cancer present
dyspepsia nausea + vomiting weight loss anorexia melaena anaemia gastric outlet obstruction
what investigations could you do for gastric cancer
laparoscopy endoscopy biopsy CT barium swallow
how could you treat gastric cancer
chemotherapy
gastrectomy
what are complications of gastric cancer
presents late so has poor prognosis
what is gastric outlet obstruction
when the pyloric sphincter does not allow the most or all of the contents of the stomach into the duodenum because it is blocked in some way
what van cause gastric outlet obstruction
strictures - usually from scar tissue of previous trauma/infection
gastritis
deformity
how may gastric outlet obstruction present
vomiting - no bile because the food can’t get past the stomach
nausea
dehydration
abdominal distention
what investigations could you do for gastric outlet obstruction
endoscopy
CT
how could you treat gastric outlet obstruction
endoscopic balloon dilatation
gastrectomy - laparoscopic or open
what is gastritis
inflammation of stomach lining
can be acute or chronic
what causes acute gastritis
stress NSAIDs alcohol uraemia burns - curlings ulcers (due to dehydration and ischaemia from burns)
what are the types of chronic gastritis
type A - autoimmune, parietal cells undergo autoimmune attack, reduced secretion of HCL and IF, atrophy of cells - VB12 deficiency
type B - bacterial, usually due to H.Pylori
type C - chemical, NSAIDs, alcohol, bile reflux
what investigations could you do for chronic gastritis
type A - bloods, look for anaemia
type B - test for H pylori - urea breath test, urinalysis, rapid slide urease test, blood for antibodies, stool microscopy and culture
how do you manage gastritis
mild - antacids of H2 receptor antagonists
moderate/severe - PPIs
treat H pylori with PPI and antibiotics
1g amoxicillin + 500mg clarithromycin
or
400mg metronidazole + 250mg clarithromycin
what are complications of gastritis
pernicious anaemia
stricture formation
mucosa associated lymphoid tissue lymphoma (MALT lymphoma)
