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MET3a > Dyspepsia, GORD and Peptic Ulcer > Flashcards

Dyspepsia, GORD and Peptic Ulcer Flashcards

1
Q

Define dyspepsia

A

Group of symptoms suggesting upper GI disease

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2
Q

Describe dyspepsia

A

Pain or discomfort in epigastrium (ulcer like)
Heart burn/regurgitation (GORD like)
Bloating, nausea, vomiting, excess wind (dysmotility like)

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3
Q

Red flag symptoms

A 
Dysphagia
Weight loss unintentional
Persistent vomiting
Epigastric mass
GI bleeding
Iron deficiency
New unexplained symptoms in >55
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4
Q

What happens if there are red flag symptoms?

A

Cancer Patient Pathway

2ww

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5
Q

Uncertainty with dyspepsia

A

Clinical diagnosis often
Non specific symptoms
Often no cause found but doesn’t mean nothing is wrong
50-75% non ulcer dyspepsia

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6
Q

Types of dyspepsia

A

Non ulcer dyspepsia (50-75%)
Peptic ulcer disease (15-25%)
Oesophagitis (5-15%)
Cancer (<2%)

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7
Q

Non ulcer dyspepsia Causes

A 
NUD
Disturbances in
- GI motility
- visceral sensation
- gastric accommodation
- intestine-gastric reflexes
- gastric acid sensitivity
- psycho-social factors
- H pylori relationship
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8
Q

GORD define

A

Symptoms and/or mucosal damage resulting from reflux of gastric contents into distal oesophagus

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9
Q

Pathophysiology of GORD

A
  • Dysfunction of OG junction = low LOS pressure and high intra-abdominal pressure so increased risk in obese and pregancy
  • decreased oesophageal acid clearance
  • delayed gastric emptying
  • gastric acid production is normal
  • H pylori role?
  • Hiatus hernia may contribute
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10
Q

Diagnosis of GORD

A 
PPI therapeutic trial in young person
Endoscopy
50% have no mucosal lesion at endoscopy
Los Angeles scoring for oesophagitis
24h pH monitoring/manometry
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11
Q

Los Angeles scoring for oesopahgitis

A 
A to D
D = stricture formation risk
A = normal
B = mild ulceration
C = severe ulceration
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12
Q

GORD Endoscopy result

A

Macroscopic oesophagitis in minority of patients

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13
Q

Complications of GORD

A

Stricture
Barrett’s oesophagus
Cancer
Extra-oesophageal manifestations

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14
Q

Extra-oesophageal manifestations in GORD

A 
Middle ear problems
Asthma
Aspiration pneumonia
Cough
Chronic sinusitis
Dental erosions and halitosis
Sore throat/pharyngitis/laryngitis
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15
Q

What is gold standard for extra-oesophageal manifestations in GORD

A

24 hour ph monitoring/manometry

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16
Q

Treatment for GORD

A 
Education and explanation
Lifestyle Modifications
Antacids and alginates
Acid suppression = PPI/H2RA
Endoscopic/surgical last resort
17
Q

Lifestyle Modifications for GORD

A 
Eliminate triggering foods and drink
Rigorously timed meals
Weight loss
Eliminate smoking
No pressure on stomach tight clothing
Sleeping at higher up position inclined
18
Q

GORD lifestyle effects

A 
Unable to enjoy meals
Sleep disturbances
Fatigue
Reduced overall productivity
Altered social well being
Altered emotional well being
19
Q

Peptic ulcers 2 types

A

Duodenal ulcer

Gastric ulcer

20
Q

Classic symptoms of peptic ulcer

A

epigastric pain

can or cannot be associated with eating

21
Q

Duodenal ulcer features

A

Pain after food or not
99% H pylori related!!!
Not malignant!

22
Q

gastric ulcer features

A 
Symptoms not reliable to diagnose
Weight loss more likely as pain while eating more than after
2/3 associated H pylori
NSAIDs significant cause!!!
5-10% malignant!
23
Q

NSAID related gastric ulcer RF

A
  • older patients >70
  • first 3m of treatment
  • smokers
  • co-morbidity
  • other drugs (anticoagulants)
24
Q

NSAIDs features for gastric ulcer

A

60% cause dyspepsia
50% NSAID ulcers are asymptomatic

Therefore tricky to spot

25
Q

H. pylori

A

Duodenal and gastric ulcer and cancer associated

2 phenotypes of mutually exclusive so will not get both at same time

26
Q

Response to H. pylori infection

A

Gastric acid secretion decreases
May develop chronic gastritis
Most people acid output returns to normal and have asymptomatic infection
Some people never pick up acid secretion so develop atrophic gastritis, gastric ulcer, cancer, lymphomas
Others have rebound of acid production so develop duodenal ulcer

27
Q

Duodenal ulcer pathway of H pylori

A

Antral gastritis
Increased acid secretion
Gastric metaplasia
Duodenal ulcer

28
Q

gastric ulcer pathway of H pylori

A

Corpus gastritis
Decreased acid secretion
gastric atrophy
Dysplasia and neoplasia

29
Q

Treatment of peptic ulcer

A

PPI = to heal and prevent recurrence sometimes
H pylori eradication = PPI and 2 ABs
Always confirm H pylori eradication = urea breath test and faecal antigen test
Stop NSAIDs
Stop smoking

30
Q

What to be careful with gastric ulcers?

A

Always biopsy
Always re-scope for healing
As can be malignant!

MET3a (38 decks)

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