Estomac: pathologies Flashcards
What is Helicobacter pylori?
Recent importance
Culture fastidieuse… why?
- bacile microaérophile… < 5% O2
What does it secrete?
- uréase: NH3 —> CO2
Which cytotoxine?
- somatostatine (-), gastrine (+)
Prevalence and incidence?
- High seropositivity, low seroconversion
What gastric pathologies are associated with H. pylori ? (5+1) (5+1)
- Gastrite antrale chronique (type B)
- Duodenal ulcers: 95%
- Gastric ulcers: 50-80%
- Gastric adenocarcinoma
- MALT carcinoma —> musoca associated lymphoid tissue carcinoma
Dyspepsie fonctionnelle (?)
What are the three main causes of peptic ulcers?
- H. pylori
- AINS
- too much HCl
What are the two main complications of peptic ulcers?
Haemorrhage
Perforation
What is the typical presentation of haemorrhage of a gastric ulcer?
Selles noirs
Hématémèse, méléna; choc hypovolémique
Tx? RÉANIMATION
- Medicaments: IPP to dim. acid
- Endoscopie: sclérose/coagulation ulcère
- Artériographie: embolisation artérielle
- Chirurgie: suture vaisseau hémorragique
What is the typical presentation of perforation of a peptic ulcer?
Acute and severe abdominal pain
Air sous les coupoles —> correspond à l’entrée d’air ou de gaz dans la cavité de l’abdomen
Abdomen de bois —> contraction rigide, tonique, permanente, douloureuse et invincible des muscles de la ceinture abdominale
Tx: Chirurgie -> suture perforation
How are ulcers diagnosed?
Typically visual diagnosis…
If in stomach:
- Biopsy and follow up to look at healing
If in duodenum:
- No need to biopsy… duodenal cancer is very rare
How is H. pylori’s presence detected? (4 main ways)
- Gastroscopie avec biopsie et culture
-
Uréase:
- CLO-test
-
Détection et présence d’anticorps:
- ELISA sérologie sérique (salivaire) pour detecter presence du IgG anti-H. pylori
- Indicates previous exposure to H. pylori but does not identify if they currently have it vs. if its gone…
-
Test de haleine
- Give radioactive *urea… if H. pylori present will be converted into radioactive form of *CO2 —> breathed out and detected in breath
- THIS TEST INDICATES IF YOU ARE A “PORTEUR ACTUEL”… bacteria must be present for this conversion to happen
How can H. pylori be treated? (6+2)
- Diet
- Stop consumption of cigarettes, alcohol and caffeine
- AINS —> stop taking if possible
- Antacids —> not enough to neutralize stomach acid
- Anti-H2 —> bloquers H2 supplantés par IPP
- IPP —> therapy typically used
***: cytoprotectors and prostaglandines —> peu utilisé ($$$)
What is the AINS strategy?
preventative treatment used to eradicate H. pylori
Are IPPs “inoffensifs”?
NO
If you stop taking them —> pH drops fast!
Dim. pH of stomach —> increase intestinal infections —> increase risk fo C. diff
What forms of treatment of H. pylori lead to its eradication?
Triple therapie:
- neutralize acid
- IPP, or pepto bismol
Two antibiotics of these 3:
- Clarithromycin
- Ampicillin
- Metronidazole
What are some of the benefits of treating H. pylori ? (8)
What is a vagotomy?
A surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion (e.g. in treating peptic ulcers).
What is an antrectomy?
procedure in which the distal third of the stomach (the gastric or pyloric antrum) is excised
What is Roux-En-Y surgery?
What are some indications for surgery?
- Resistance to medical treatment
- Cicatrisation sténosante au pylore —> dilation
- Hémorragie —> simple réparation
- Perforation —> simple réparation
Vagotomy and antrectomy are falling into a state of disuse
What are the two different types of chronic gastritis?
-
Gastrite antrale:
- secondary to H. pylori —> type B
-
Gastrite fundique:
- autoimmune —> type A
- no digestive symptoms
- presence of anti-parietal cell antibodies
- (Hypochlorhydria —> hypergastrinemia)
- Macrocytic anemia —> B12 deficit —> Megaloblastic anemia