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GI > Dyspepsia and peptic ulcer disease > Flashcards

Dyspepsia and peptic ulcer disease Flashcards

1
Q

What is dyspepsia?

A

Epigastric pain or burning
Postprandial fullness
Early satiety

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2
Q

What are the 2 ends of the foregut?

A

Cricopharyngeus to the ampulla of vater

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3
Q

What are the organic causes of dyspepsia?

A

Peptic ulcer disease
Drugs (NSAIDS and COX2 inhibitors)
Gastric cancer

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4
Q

What are the functional causes of dyspepsia?

A

No evidence of culprit structutral disease

Associated with other functional gut disorders (IBS)

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5
Q

What is it important to differentiate between in a history of dyspepsia?

A

Dyspepsia and heartburn/reflux

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6
Q

What can be found upon examination?

A 
Epigastrric tenderness
Cachexia
Mass
Evidence gastric outflow obstruction - vomiting, swishing of gastric contents 
Peritonism
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7
Q

What are the ALARM symtoms?

A 
Dysphagia 
Evidence of GI blood loss 
Persisting vomiting 
Unexplained weight loss
Upper abdominal mass
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8
Q

What should be done in the management of dyspepsia in the absence of alarm symptoms?

A

Non invasive test and treat - check H. Pylori status and eradicate if infected to remove the risk of gastric cancer
If HP negative, trerat with acid inhibition as required

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9
Q

What is the critera foro functional dyspepsia?

A 
Bothersome postprandial fullness 
Early satiation 
Epigastric pain 
Epigastric burning 
No evidence of structural disease
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10
Q

What can cause functional dyspepsia?

A 
Visceral hypersensitivity 
Altered brain-gut interactions 
Genetic factors 
Pychosocial factors 
Abnormal upper GI motor and reflex functions 
Disrupted gut-immune interactions
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11
Q

What is peptic ulcer disease?

A 
A common cause of organic dyspepsua
Pain predominant dyspepsia (to back)
Often nocturnal 
Aggravated or relieved by eating 
Relapsing and remitting chronic illness
Family history common
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12
Q

What can cause peptid ulcer disease?

A

H pylori
NSADS, COX1, BOX22, PGE
Gastric motility
Outflow obstruction

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13
Q

What is H. Pylori?

A

A gram negative microaerophilic flagellated bacillus that is acquired in infancy. It spreads via oral-oral/ faecal oral spread

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14
Q

What are the consequences of H. Pylori?

A

Peptic ulcer disease (duodenal ro gastric) and gastric cancer

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15
Q

What types of gastric cancer can H. Pylori cause?

A

Non-cardia gastric adenocarcinoma

Low grade B-cell gastric lymphomas

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16
Q

How do peptic ulcers arise?

A

Food stimulates G cells to release gastrin which then stimulates parietal cells to produce HCl in the gastric fundus. When H. Pylori is present, is will overstimualte G cells and therefore produce a hyperacidic state.

17
Q

How is a H. Pylori infection diagnosed?

A

Gastric biopsy (urease test, histology, cultire/sensitivity)
Urease breath test
FAT (faecal antigen test)
Serology (IgA antibodies) - not accurate with increasing patient age

18
Q

How does H. Pylori increase the pH of its microenvironment?

A

It breaks down urea into ammonium bicarbonate via urease

19
Q

What are examples of PPIs?

A

Ompreazole, esomeprazole, lansoprazole, dexlansoprazolle

20
Q

How are PUDs treated?

A 
All antisecretory therapy (PPI)
All test for presence of H. Pylori 
If positive treat 
Withdraw NSAIDs
Lifestyle
Non-HP/ non-NSAID ulcers - nutrition and optimise comoridities
21
Q

How is H. Pylori treated?

A

Triple therapy for 1 week (PPI + amoxicillin + clarithomycin)

22
Q

What are common complications of PUD?

A

Anaemia
Bleeding
Perforation
Gastric outlet/duodenal obstruction

23
Q

When is gastric cancer suspected?

A

Dyspepsia with alarm symptoms (weight loss, anaemia, mass, recurrent vomiting)

24
Q

What can increase the risk of gastric cancer?

A

Achlorhydria

Family history

25
Q

What is the histology of gastric cancer?

A

Body = predominant or pangiastritis
Atrophy
Intestinal metaplasia

26
Q

What is the bacteriology of gastric cancer?

A

H. Pylori disappear

Mixed bacterial growth

27
Q

How does H. Pylori inhibit gastric acid secretion?

A

Direct effect of bacterial produce (ammonia)

Effect of body inflammation induced by H. Pylori 0 IL-B which is a powerful inihibitor of acid secretion

GI (42 decks)

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