Gastric disease Flashcards
What is dyspepsia?
Pain or discomfort in the upper abdomen
“Indigestion”
What are the clinical features of dyspepsia?
Epigastric discomfort Fullness or bloating Excessive flatus Nausea and/or vomiting Fatty food intolerance
List some “red flag” symptoms and describe what should be done if a patient experiences any of them
Anorexia Loss of weight Anaemia Recent onset / patient >55yrs / persistent despite treatment Malaena / haemoptysis or Mass Swallowing problems (dysphagia)
Give four pathologies that are associated with dyspepsia
Peptic ulcer disease
Oesophagitis
H. pylori infection
Functional dyspepsia (no significant physical abnormality)
Which drugs can potentially cause or exacerbate dyspepsia?
NSAIDs steroids bisphosphates Ca antagonists nitrates theophyllines
Describe the management for dyspepsia
Treat any underlying disease e.g. H. pylori
Drugs - PPIs, H2R antagonists
Lifestyle changes
What is gastritis?
Inflammation of the gastric mucosa
What are the three pathological types of gastritis?
Autoimmune
Bacterial (most common)
Chemical injury
What are the potential complications of gastritis?
Stomach ulcer Gastric bleeding (can lead to anaemia)
Give two types of peptic ulcer
Gastric ulcer
Duodenal ulcer
Describe the aetiology of peptic ulcers
H. pylori is most common cause NSAIDs Smoking, alcohol Stress Rare causes e.g. Zallinger-Ellison syndrome, hyperparathyroidism, Crohn's disease
What symptoms are associated with peptic ulcers?
Epigastric pain Nausea, vomiting Oral flatulence Bloating, distension Intolerance of fatty food Pain may radiate to back
What clinical signs are associated with peptic ulcers?
Epigastric tenderness
Weight loss
Possible succession splash
Describe the pathological causes of peptic ulcers
Imbalance between acid secretion and mucosal barrier
H. pylori association - bacteria increases gastric acid which overcomes the mucosal barrier
Which investigations should be done when peptic ulcer is suspected?
FBC to test for anaemia
Test for H. pylori
Endoscopy - usually not required unless patient is older than 55 or alarm signs are present
Describe the management of peptic ulcers
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
What are the potential complications associated with peptic ulcers
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
What are the possible causes of gastric outlet obstruction?
benign causes e.g. strictures, ulcer
malignancies
Describe the clinical features of gastric outlet obstruction
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
How is gastric outlet obstruction treated?
Endoscopic dilatation
Surgery
What type of bacteria is Helicobacter pylori?
Gram negative
Spiral shaped
Flagellated
What type of mucosa does H. pylori colonise?
Gastric type mucosa
- resides in surface mucus layer, does not penetrate epithelial layer
Describe the non-invasive techniques for diagnosing H. pylori infection
Serology (IgE)
13C/14C urea breath test
Stool antigen test
Describe the invasive techniques for diagnosing H. pylori infection
Endoscopy and biopsy
- histology
- culture of gastric biopsies
- rapid slide urease test
