Dyspepsia & Peptic ulcer disease Flashcards
Define dyspepsia.
Epigastric pain or burning.
What symptoms of dyspepsia are associated with eating meals?
- Post pandrial fullness 2. Early satiety
What are some of the causes of Dyspepsia?
- Peptic ulcer disease 2. Drugs 3. IBD 4. Gastric cancer
Dyspepsia can be often confused with which disease?
Heartburn/acid reflux
What is the primary clinical finding upon examination in dyspepsia?
What other findings might be seen in complicated dyspepsia?
Tenderness in the epigastric region
Complicated dyspepsia can present with- Cachexia, mass, peritonism, gastric outflow obstruction
What are the ALARM symptoms of dyspepsia?
- Anaemia
- Loss of weight
- Anorexia
- Recent onset
- Malaena (swallowing of blood)
What needs to be checked if the ALARM symptoms are missing?
Check H.pylori status
Why is it important to treat H.pylori in dyspepsia?
Treats ulcer disease
Reduces risk of gastric cancer.
If HP negative treat with acid inhibition
What is functional dyspepsia?
Dyspepsia without any abnormal mass or ulcerations in the upper GI tract.
What is the most common cause of Organic dyspepsia?
Peptic ulcer disease
Peptic ulcer disease causes pain predominant dyspepsia. T/F?
True
Peptic ulcer disease isnt nocturnal. T/F?
False
Peptic ulcer disease can be both aggrevated & relieved by eating. T/F?
True
Two main causes of peptic ulcer disease (PUD)?
- H. pylori
- NSAID’s (ibuprofen, aspirin)
H.pylori is a Gram _ microaerophillic flagellated _.
Negative
Bacilli
Most cases of H. pylori infilration do not cause pathology, but what are the two pathological effects of it?
- PUD
- Duodenal ulcers
- Gastric ulcers - Gastric cancer
H. pylori is more prevalent in developing countries and affects the lower class more than the upper. T/F?
False- Developed countries, lower class more than upper class part TRUE
What are the pathological changes that lead to duodenal ulcers (5)
- Increased Acid secretion in the stomach due to H.pylori colonisation. (via increased gastrin)
- Increased Duodenal acid load
- Gastric metaplasia (duodenum lining changes to gastric lining)
- Further H. Pylori colonisation- damaging mucosa.
- Increased acid secretion = Ulceration.
What are the pathological steps leading to gastric cancer?
- H.pylori increases acid secretion via gastrin
- Mucosa damaged, increased acid & H.pylori = forms ulcer
- Ulcer leads to scarring and Atrophy of the mucosa
- Atrophy leads to dysplasia then cancer.
What tests are undertaken to confirm H.pylori infection?
- Gastric biopsy
- Urease breath test
- FAT- Faecal antigen testing
- Serology (IgA testing)
Why is the Urease breath test used for H.pylori testing?
H.pylori increases the pH of its micro-environment by producing ammonium bicarbonate.
This can be tested for in a persons breath.
What are the anti-secretory treatments used in PUD? (2) (give two eg for each type)
- H2RA’s–> block action of histamine at H2 receptors in the parietal cells of the stomach–> Decreases Acid production
Eg- Cimetidine, Ranitidine
- PPI’s (proton pump inhibitor)- Omeprazole, lansoprazole.
What medications are used to promote healing of duodenal ulcers? (2)
- Antacids
- Sucralfate
What standard antibiotics are used in H.pylori infections?
Amoxicillin or Clarithromycin.
Triple therpay
- PPI + amoxicillin + clarithro
- PPI + Metronidazole (Gut antibiotic) + clarithromycin
Common complications of PUD? (4)
- Anaemia
- Perforation
- Bleeding
- Fibrotic scar- gastric outlet/duodenal obstruciton
What are the symptoms of gastric cancer?
Dsypepsia & ALARM signs
What interleukin is critical in the development of gastric cancer?
IL-1B
How does H.pylori , with the production of IL-1B lead to gastric cancer?
- H.pylori colonisation
- Mucosal inflammation
- IL-1B release
- IL-1B- inhibits acid secretion- Acid Hyposecretion
- Body predominant Gastritis
- Atrophic Gastritis
- Cancer
