Gastric disease Flashcards
Name 4 acute causes of gastritis
Alcohol
irritant chemical injury
severe burns
shock/trauma
What is H.Pylori?
Gram -ve flagellated bacillus
What is PUD?
Peptic ulcer disease
Breach in GI mucosa due to a failure of defense against acid and pepsin attack
Where are PUD found?
Stomach
Duodenum
Macroscopically how do PUD look?
Edges clear cut and punched out
The causes of PUD and gastritis are very similar but what are the two most common?
H.pylori
NSAIDS
How does H.pylori damage the GI mucosa?
H.pylori lives between epi and mucous barrier
Releases ammonia and proteases which damage epi
This allows mucosal barrier to be exposed to HCl
What enzyme do we test for in breath test for diagnosing H.pylori?
Urease (this enzyme creates ammonia)
First line of investigation of PUD?
Carbon-13 urea breath test (same to test if someone has got rid of H.pylori)
What treatment is used for H.pylori? When do you retest?
Triple therapy for 7 days PPI Amoxicillin Clarithromycin/metronidazole (PAM/PAC)
Retest after 6-8 weeks
What is dyspepsia?
A collection of symtpoms Epigastric pain syndrome -Epigastric pain -Bloating -Reflux
Post prandial distress syndrome
- Post prandial fullness/early satiety
- Nausea/vomiting
What is the difference between organic and functional dysppesia?
Organic - know what the underlying cause is - structural issues e.g. PUD, GORD etc.
Functional - no evidence of structural disease
What are the ALARM symtpoms?
A - anaemia L - loss of weight A - anorexia R - recent onset of progressive symtoms M - masses and melena/haematemesis S - swallowing difficultes
If a patient presents with dyspesia/GORD when would they immediately get an upper GI endoscipy?
ALARM
OR
over 55
How do you manage and treat dyspesia in the absence of ALARM sytpoms?
- Lifestyle changes - classic lot
- Reduce/stop use of NSAIDS
- Test for H.pylori
PPI treatment for 1month
What is the biggest risk factor for gastric cancer? And what are 3 other risk factors?
H.pylori
Diet high in processed meats
Obesity
Smoking
Name the 3 kinds of gastric canker?
90% adenocarcinoma
- intestinal (more polyp)/diffuse (worse outcome and into the wall of stomach)
Lymphomas - most in MALT
Carcinoid and stromal tumours (rare)
What is the Virchow’s Node?
Lymph node above left clavicle - gastric cancer often mestassis to there
What is gastroparesis?
Delayed gastric empyting that is NOT due to an obstruction
How do you investiagte gastroparesis?
Gastric emptying studies
Manometry
How to manage gastroparesis?
Nutritional support
Metroclopramide
Surgery
What must be ensured before performing the carbon-13 urea test?
No PPIs for 2 weeks
No antibiotics for 4 weeks
Why does NSAID use cause gastritis and PUD?
Decrease prostaglandin production via COX-2 inhibition -> increased acidity
(PGE2 and PGI2 decrease pH)
What are the symptoms of PUD?
Pain predominant dyspesia Often nocturnal symtpoms - aggrevated/relived by eating Relapsing and remitting Nausea/vomiting Reflux
How do you treat a paitent with PUD that is -ve for H.pylori
NSAID user
- stop NSAID use
- full dose PPI for 8 weeks
- ve for NSAID and H.pylori
- full dose PPI 4-8 weeks
Symptoms of gastroparesis?
Bloating
Abdo pain
Fullness
Nausea/vomiting after meals
What 3 things are known to cause gastroparesis?
Chemo
Diabetes
Weed smoking
Symptoms of gastric cancer?
ALARM/ > 55 yo
Dyspepsia
Treatment of gastric cancer
Surgery
Chemo/radio
MALT - remision in most cases by H.pylori treatment
Investigation of gastric cancer?
Endoscopy and biopsy
CT scan
What pain is associated with eating in terms of duodenal and gastric ulcers?
Duodenal - pain relieved by eating
Gastric - pain worsened by eating
What is Fe2+ anaemia associated with gastrically?
Gastric cancer
Gastric ulcer
