Dyspepsia, peptic ulcer disease, gastritis Flashcards
What are ALARMS symptoms?
Anaemia (iron deficiency), Loss of weight, Anorexia, Recent onset/progressive symptoms, Melaena/haematemisis, Swallowing difficulty
If below 55 and H.Pylori positive, how should the patient be treated? Post test and treat
Triple therapy: Amoxicillin, clarithromycin and PPI for 1 week.
Who should be referred for an upper GI endoscopy?
All with dysphagia or ALARMS signs or above 55 with persistent symptoms.
Draw the NICE treatment guidelines algorithm for dyspepsia
Page 253
What are risk factors for duodenal ulcer?
H.Pylori, drugs (NSAIDs, steroids, SSRIs), increased gastric acid secretion, increased gastric emptying causing low duodenal pH, Smoking
What are symptoms of duodenal ulcer?
Asymptomatic or epigastric pain relieved by antacids and loss of weight.
What is a sign of a duodenal ulcer?
Epigastric tenderness
How is a duodenal ulcer diagnosed?
Upper GI endoscopy. Test for H.pylori. Measure gastrin concentrations when off PPIs if Zollinger-Ellison syndrome is suspected.
What are differentials for duodenal ulcers?
TB, lymphoma, duodenal Crohns, pancreatic cancer, non-ulcer dyspepsia
Who do gastric ulcers mainly occur in and where?
More common in elderly people in the lesser curve of stomach - elsewhere, more malignant.
What are risk factors for gastric ulcers?
H.Pylori, smoking, NSAIDs, reflux of duodenal contents, delayed gastric opening, stress, neurosurgery/burns
What are symptoms of gastric ulcer?
Epigastric pain, especially upon eating +/- loss of weight.
What tests are performed for gastric ulcers?
Upper GI endoscopy to exclude malignancy. Multiple biopsies from ulcer rim and base - sent to histology. Repeat endosocpy after 6-8 weeks to confirm healing and exclude malignancy.
What are risk factors for gastritis?
Alcohol, NSAIDs, H.pylori, Reflux/hiatus hernia, atrophic gastritis, granulomas (Crohn’s, sarcoidosis), CMV, Zollinger-Ellison, Mentrier’s disease
What are the types of gastritis?
Gastritis is defined as the histological presence of gastric mucosal inflammation.
Erosive gastritis is gastric mucosal erosion caused by damage to mucosal defenses. It is typically acute, manifesting with bleeding, but may be subacute or chronic with few or no symptoms.
Stress gastritis, most commonly related to mucosal ischaemia seen in critically ill patients, represents a continuum of disease ranging from superficial (erosions) to deep mucosal damage known as stress ulceration.
Autoimmune gastritis is a diffuse form of mucosal atrophy characterised by auto-antibodies to parietal cells and intrinsic factor resulting in inflammatory infiltration and atrophy of the corpus mucosa.
Phlegmonous gastritis is a rare but life-threatening infection of the gastric submucosa and muscularis propria seen in immunocompromised patients. Bacterial infection.
What are key diagnostic factors present in gastritis?
Epigastric pain, Presence of risk factors, Nausea, vomiting, loss of appetite
How is gastritis treated?
Treat preventatively with ranitidine/omeprazole (H2 antagonist/PPI)
Alternate is misoprostol oral (synthetic prostaglandin)
H Pylori eradication therapy
Lifestyle change
If autoimmune, likely to have B12 malabsorption so treat with IM cyanocobalamin once a month
What are tests for H.Pylori?
Invasive:
CLO test (biopsy from gastroscopy): Rapid urease test (detects camptlobacter like organism)
Histology
Culture
Non-invasive:
13C breath test
Stool antigen
Serology
How is bile reflux caused gastritis treated?
Rabeprazole 20mg oral OD
Sucralfate 1g oral QD
