Gastric disease

Question 1

What is dyspepsia?

Answer 1

Pain or discomfort in the upper abdomen

“Indigestion”

Question 2

What are the clinical features of dyspepsia?

Answer 2

Epigastric discomfort
Fullness or bloating
Excessive flatus
Nausea and/or vomiting
Fatty food intolerance

Question 3

List some “red flag” symptoms and describe what should be done if a patient experiences any of them

Answer 3

Anorexia
Loss of weight
Anaemia
Recent onset / patient >55yrs 
 / persistent despite treatment
Malaena / haemoptysis or Mass
Swallowing problems (dysphagia)

Question 4

Give four pathologies that are associated with dyspepsia

Answer 4

Peptic ulcer disease
Oesophagitis
H. pylori infection
Functional dyspepsia (no significant physical abnormality)

Question 5

Which drugs can potentially cause or exacerbate dyspepsia?

Answer 5

NSAIDs
steroids
bisphosphates
Ca antagonists
nitrates
theophyllines

Question 6

Describe the management for dyspepsia

Answer 6

Treat any underlying disease e.g. H. pylori
Drugs - PPIs, H2R antagonists
Lifestyle changes

Question 7

What is gastritis?

Answer 7

Inflammation of the gastric mucosa

Question 8

What are the three pathological types of gastritis?

Answer 8

Autoimmune
Bacterial (most common)
Chemical injury

Question 9

What are the potential complications of gastritis?

Answer 9

Stomach ulcer
Gastric bleeding (can lead to anaemia)

Question 10

Give two types of peptic ulcer

Answer 10

Gastric ulcer

Duodenal ulcer

Question 11

Describe the aetiology of peptic ulcers

Answer 11

H. pylori is most common cause
NSAIDs
Smoking, alcohol
Stress
Rare causes e.g. Zallinger-Ellison syndrome, hyperparathyroidism, Crohn's disease

Question 12

What symptoms are associated with peptic ulcers?

Answer 12

Epigastric pain
Nausea, vomiting
Oral flatulence
Bloating, distension
Intolerance of fatty food
Pain may radiate to back

Question 13

What clinical signs are associated with peptic ulcers?

Answer 13

Epigastric tenderness
Weight loss
Possible succession splash

Question 14

Describe the pathological causes of peptic ulcers

Answer 14

Imbalance between acid secretion and mucosal barrier

H. pylori association - bacteria increases gastric acid which overcomes the mucosal barrier

Question 15

Which investigations should be done when peptic ulcer is suspected?

Answer 15

FBC to test for anaemia
Test for H. pylori
Endoscopy - usually not required unless patient is older than 55 or alarm signs are present

Question 16

Describe the management of peptic ulcers

Answer 16

Lifestyle modification
H. pylori eradication
Drug therapy (PPIs)
Endoscopic intervention for bleeding ulcers
Treat complications as they arise
Surgery may be indicated in complicated peptic ulcer disease

Question 17

What are the potential complications associated with peptic ulcers

Answer 17

Acute GI bleeding - malaena, haematemesis
Chronic bleeding can cause iron deficiency anaemia
Gastric outlet obstruction due to oedema or stricture
Perforation (causes epigastric pain)
Fibrotic strictures caused by scarring
Adverse reactions to drugs

Question 18

What are the possible causes of gastric outlet obstruction?

Answer 18

benign causes e.g. strictures, ulcer

malignancies

Question 19

Describe the clinical features of gastric outlet obstruction

Answer 19

Vomiting
 - lacks bile, contains fermented foodstuffs
Early satiety, abdominal distension, weight loss
Dehydration
 - loss of H+ and Cl- in vomit
Metabolic alkalosis
Low Cl, Na, K in blood
Renal impairment

Question 20

How is gastric outlet obstruction treated?

Answer 20

Endoscopic dilatation

Surgery

Question 21

What type of bacteria is Helicobacter pylori?

Answer 21

Gram negative
Spiral shaped
Flagellated

Question 22

What type of mucosa does H. pylori colonise?

Answer 22

Gastric type mucosa

- resides in surface mucus layer, does not penetrate epithelial layer

Question 23

Describe the non-invasive techniques for diagnosing H. pylori infection

Answer 23

Serology (IgE)
13C/14C urea breath test
Stool antigen test

Question 24

Describe the invasive techniques for diagnosing H. pylori infection

Answer 24

Endoscopy and biopsy

• histology
• culture of gastric biopsies
• rapid slide urease test

Question 25

How is H. pylori infection eradicated?

Answer 25

Triple therapy for 7 days

• clarithromycin 500mg bd
• Amoxycillin 1g bd or metronidazole 400mg bd (tetracycline if penecillin allergic)
• PPIs eg ameprazole 20mg bd