Gastric Disease

Question 1

What are the symptoms of dyspepsia?

Answer 1

Upper abdominal discomfort
Retrosternal pain
Anorexia
Nausea
Vomiting
Bloating
Early satiety
Heartburn

Question 2

What are the ALARMS symptoms to look for when considering referring for endoscopy?

Answer 2

Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia

Question 3

What blood tests should be done in a patient with dyspepsia?

Answer 3

FBC
Ferritin
LFTs
U&Es
Calcium
Glucose
Coeliac serology/serum IgA

Question 4

Describe H.Pylori

Answer 4

Gram negative
Spiral-shaped
Microaerophilic
Flagellated

Question 5

How is H.Pylori diagnosed?

Answer 5

Serology: IgG against H. pylori
13C /14C Urea Breath Test
Stool antigen test – ELISA - need to be off PPI for 2 weeks
Invasive-Histology: gastric biopsies stained for the bacteria
Culture of gastric biopsies
Rapid slide urease test (CLO)

Question 6

What are three types of gastritis?

Answer 6

Autoimmune-development of antibodies against the gastric parietal cells
Bacterial- H.Pylori infection
Chemical- bile, NSAIDS, alcohol
Also are more predisposed to gastritis from several endocrine disorders

Question 7

What are the symptoms of peptic ulcers?

Answer 7

Epigastric pain is the main feature (pointing sign, may be relieved by antacids)
Nocturnal/hunger pain (more common in DU)
Back pain (may suggest penetration of a posterior DU)
Nausea and occasionally vomiting
Weight loss and anorexia
Only sign may be epigastric tenderness
If the ulcer bleeds, patients may present with haematemesis and/or melaena, or anaemia

Question 8

What is the eradication therapy for H. Pylori infection?

Answer 8

Triple therapy
Clarithromycin
Amoxycillin or metronidazole (tetracycline if penicillin allergic)
PPI such as omeprazole

Question 9

What are the signs and symptoms of gastric outlet obstruction?

Answer 9

Vomiting – lacks bile, fermented foodstuffs
Early satiety, abdominal distension, weight loss, gastric splash
Dehydration and loss of H+ and Cl- in vomit
Metabolic alkalosis
Bloods – low Cl, low Na, low K, renal impairment

Question 10

How do patients present with gastric cancer?

Answer 10

Dyspepsia, early satiety, nausea & vomiting, weight loss, GI bleeding, iron deficiency anaemia, gastric outlet obstruction