Gastric disease

Question 1

Define dyspepsia (3)

Answer 1

Upper GI symptoms for more than 4 weeks including upper abdominal pain, reflux, heartburn, nausea, vomiting.

Question 2

Describe GORD
Define (1)
Common in (2)
Symptoms (3)
Consequences (4)

Answer 2

Gastric oesophageal reflux disease
Common with raised intracranial-abdominal pressure ie in pregnancy or obesity.
Symptoms: chest pain, cough, acid taste
Consequences: nothing, oesophagitis (inflammation), benign strictures, Barrett’s oesophagus.

Question 3

Treatments of GORD (7)

Answer 3

Lifestyle modifications: eating earlier, avoiding trigger foods, avoiding high intra-abdominal pressure.
Pharmacological: antacids, H2 anatagonists, PPIs.
Surgical: rare and can cause dysphagia.

Question 4

Explain why having a hiatal hernia will increase reflux. (3)

Answer 4

LOS in the thorax - reduced tone of the sphincter, not compressed by the diaphragm, angle on entry to the stomach changed.

Question 5

Describe symptoms of gastritis (6)

Answer 5

Pain, nausea, vomiting, bleeding, endoscopic appearance, inflammation of mucosa.

Question 6

Describe acute gastritis.
Causes (4)
Pathophysiology (3)
Treatment (1)

Answer 6

NSAID use, alcohol overuse, chemo, bile reflux from duodenum.
Damage to epithelial cells and reduced mucus production, causing vasodilation and oedema.
Remove the irritant.

Question 7

Describe causes of chronic gastritis (6)

Answer 7

Bacterial - H pylori infection
Autoimmune - autoantibodies to parietal cells leads to pernicious anaemia from lack of B12
Chemical - chronic alcohol or NSAID use

Question 8

Describe the pathophysiology of H pylori (5)

Answer 8

Helix shaped, gram negative, microaerophilic.
Faecal-oral or oral-oral
Produces urease which converts local urea to ammonium to raise pH, which is toxic to epithelium.
Also has cytotoxins for direct epithelial injury, and promotes inflammatory response.

Question 9

Describe how the location of H pylori can change its presentation. (5)

Answer 9

Antrum: increased Gastrin secretion - more acid - duodenal metaplasia and ulceration.
Antrum and body: asymptomatic
Body: atrophic effects on parietal cells - gastric ulcer

Question 10

Describe the diagnosis and treatment of H pylori. (4)

Answer 10

Urea breath test using carbon-13
Stool or blood antigen test
PPIs
Amoxicillin or metronidazole

Question 11

Describe the pathophysiology of peptic ulcer disease. (5)

Answer 11

Break down of normal defences.
Mucosal injury (alcohol, H pylori, smoking)
Acute: acute gastritis causes ulcers
Chronic: ulcers form at mucosal junction.
Generally small with necrotic base

Question 12

Describe the clinical consequences of peptic ulcer disease. (5)

Answer 12

Scar tissue shrinkage can narrow lumen
Perforation causing peritonitis
Erosion into adjacent structures
Haemorrhage from vessels
Malignancy

Question 13

Describe symptoms of peptic ulcer disease (3)

Answer 13

Epigastric pain - stomach immediate presentation on eating, duodenal 2 hours later.
Anaemia/bleeding, weight loss.

Question 14

Management of peptic ulcer disease. (4)

Answer 14

Lifestyle modification, stopping triggers, eradicating H pylori, PPI.

Question 15

Describe 4 tests you would perform if one of these were suggested.

Answer 15

Upper GI endoscopy - biopsy ulceration, sample for H pylori
Urea breath test
Erect CXR - perforation
Blood tests for anaemia.

Question 16

Describe Zollinger-Ellison Syndrome. (4)

Answer 16

Gastrin secretin tumour of the pancreas causes proliferation of parietal cells leading to lots of acid, ulceration, abdominal pain disease and diarrhoea.

Question 17

Describe stress ulceration. (2)

Answer 17

Symptoms of ulceration following huge physiological stress: burns, raised ICP, sepsis, severe trauma.

Question 18

Which two arteries can be invaded into with gastric ulcer disease?

Answer 18

Peptic ulcer - splenic artery

Duodenal ulcer - gastroduodenal artery.