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Yr 2 - GI & Metabolism > Dyspepsia > Flashcards

Dyspepsia Flashcards

1
Q

What do goblet cells secrete?

A

Mucus (protects stomach lining)

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2
Q

What do parietal cells secrete?

A

Gastric acid (e.g. HCl)

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3
Q

What do chief cells secrete?

A

Pepsinogen (protease precursor)

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4
Q

What do D cells secrete?

A

Somatostatin (inhibits acid secretion)

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5
Q

What do G cells secrete?

A

Gastrin (stimulates acid secretion)

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6
Q

What has positive effect on parietal cells?

A

Histamine, gastrin and ACh –> increases gastric acid production

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7
Q

What is ACh released by?

A

Enteric neuron

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8
Q

What is effect of somatostatin?

A

Inhibitory on gastric acid secretion (parietal cells), histamine and gastrin (G cells)

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9
Q

How do proton pump inhibitors and H2 blockers reduce gastric acid secretion?

A

Inhibit pathways

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10
Q

What are the different dyspepsia terms?

A
  1. Dyspepsia with alarm symptoms: Dyspepsia with “red-flag” features
  2. Uncomplicated (or simple) dyspepsia: Dyspepsia without “red-flag” features
  3. Uninvestigated dyspepsia: Dyspepsia presenting to a physician for the first time
  4. Functional (“non-ulcer”) dyspepsia: Dyspepsia, but no structural cause for symptoms at upper GI endoscopy
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11
Q

What are the alarm features of dyspepsia?

A 
Weight loss
Dysphagia or odynophagia
Persistent vomiting
Haematemesis or melaena
Palpable epigastric mass
Family history of gastric cancer
Dyspepsia onset over age of 45-55 years
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12
Q

What are the potential causes of dyspepsia?

A
  • Gastro-oesophageal reflux disease
  • Peptic ulcer
  • Gastric cancer

But ~80% of people with dyspepsia will have a normal endoscopy –> This is so-called functional dyspepsia

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13
Q

How is dyspepsia with alarm symptoms managed?

A

Urgent endoscopy (but accuracy poor in predicting upper GI cancer)

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14
Q

What are individuals with dyspepsia tested for?

A

H. pylori (eradication therapy for positives)

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15
Q

How do we decide which approach to use for dyspepsia?

A
  1. Prompt endoscopy:
    Is best in terms of effect on symptoms
    But, costs much more per patient
    Not cost-effective
  2. “Test & treat” for H. pylori or empirical PPI therefore preferable:
    Effect on both symptoms and costs very similar
    Which to use depends on population prevalence of H. pylori
    If prevalence >10%, “test and treat” preferred
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16
Q

Symptoms of peptic ulcer?

A
  • Epigastric pain (May come on after eating, May be relieved by antacids, eating, or drinking milk)
  • Epigastric tenderness
  • Nausea
  • Anorexia
  • Weight loss
17
Q

What are the causes of peptic ulcers?

A

Commonest causes:
H. pylori
Non-steroidals and aspirin

Rarer causes:
Zollinger-Ellison syndrome
Crohn’s disease

18
Q

How often are peptic ulcers present in endoscopies for dyspepsia?

A

<10%

19
Q

What is H. pylori (Helicobacter Pylori)?

A
  • Causally implicated in peptic ulcer disease: 60% of gastric and 80% of duodenal ulcer
  • Classed as a human carcinogen by WHO:
  • Strong association with gastric cancer
  • 5% of dyspepsia attributable to H. pylori
20
Q

What is eradication therapy for H. pylori?

A

Proton pump inhibitor (PPI) combined with two antibiotics e.g. amoxicillin, clarithromycin, metronidazole

21
Q

How does H. pylori survive?

A

Bacterium produces urease:

  1. Converts urea to ammonia and water
  2. A cloud of ammonia neutralises the acidic pH of the stomach
  3. Allows H. pylori to survive
22
Q

How can H. pylori be diagnosed non-invasively?

A
  • Carbon urea breath test
  • H Pylori serology
  • H Pylori stool antigen test (can also confirm its eradication)
23
Q

How can H. pylori be diagnosed invasively?

A
  • Rapid urease test

- Histological examination of biopsy specimens

24
Q

What are complications of peptic ulcer?

A
  • Perforation (ulcer erodes through stomach or duodenum wall)
  • Bleeding
  • Gastric outlet obstruction (pyloric stenosis)
25
Q

How can bleeding caused by peptic ulcer be treated?

A

Endoscopy –> Injection of adrenaline / heat to bleeding vessel) / surgery

26
Q

How is gastric outlet obstruction (pyloric stenosis) treated?

A

Bypass procedure (surgery)

27
Q

What are the symptoms of peptic ulcer bleeding?

A 
Haematemesis
Coffee-ground vomiting
Melaena
Rectal bleeding
Tachycardia
Hypotension
28
Q

As H. pylori prevalence decreases, so does what?

A

Ulcer incidences

Yr 2 - GI & Metabolism (51 decks)

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