GASTRIC DISEASE Flashcards

1
Q

what type of stomach cancer is most common?

A

adenocarcinoma from gastric mucosa

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2
Q

What are the risk factors for gastric cancer?

A

male
inc age
H pylori (6x risk)
smoking alcohol

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3
Q

How can h pylori infection result in cancer?

A

produces urease enzyme which breaks down urea into CO2 and ammonia. This creates an alkaline environment which sets off a cycle of epithelial damage, ulceration, inflammation and neoplasia.

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4
Q

What kind of bacteria is h pylori?

A

its a gram negative helical bacteria

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5
Q

How does gastric cancer present?

A
often vague and non-specific
dyspepsia
dysphagia 
early satiety
vomiting
melaena
non-specific symptoms (in late disease)
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6
Q

What are some signs of gastric cancer on examination? at what stage do they appear?

A

mass in epigastrium - late in disease

palpable left supraclavicular node (virchow node) - metastatic abdominal malignancy

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7
Q

How should ?gastric cancer be investigated?

A

urgent OGD + biopsy

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8
Q

What biopsies should be taken for query gastric cancer?

A

histology
CLO test for h pylori
HER2/neu protein expression for targeted therapies

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9
Q

What further investigation is needed to plan treatment for a confirmed gastric cancer?

A

CT chest abdo pelvis

staging laparoscopy for peritoneal mets

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10
Q

How is gastric cancer managed?

A

total or subtotal gastrectomy where oesophagus joins small bowel directly + chemotherapy

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11
Q

How can gastric cancer confined to the mucosa be treated?

A

endoscopic mucosal resection

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12
Q

Give some side effects of gastrectomy

A

death
anastamostic leak
dumping syndrome
vit B12 deficiency

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13
Q

What is dumping syndrome?

A

sudden passage of large volume of gastric contents into small intestine resulting in an intraluminal fluid shift and subsequent intestinal distention. causes nausea, vomiting, diarrhoea and hypovolaemia (tachycardic, sweating)

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14
Q

What red flag symptoms require urgent upper endoscopy for query malignnacy?

A

Patients with dysphagia

Any patient >55yrs with weight loss and upper abdominal pain, dyspepsia, or reflux

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15
Q

Describe surgical intervention for GORD

A

fundoplication, whereby the gastro-oesophageal junction and hiatus are dissected and the fundus wrapped around the GOJ, recreating a physiological lower oesophageal sphincter

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16
Q

What is a hiatus hernia?

A

where an abdominal organ protrudes through the oesophageal hiatus

17
Q

What are the 2 types of hiatus hernia?

A

sliding

rolling

18
Q

What is a sliding hiatus hernia?

A

most common type

GOJ, oesophagus + cardia of stomach move upward into thorax

19
Q

What is a rolling hiatus hernia?

A

gastric fundus moves into thorax but GOJ does not so a bubble forms, “true hernia”

20
Q

Which type of hiatus hernia is more prone to strangulation and volvulus?

A

rolling

21
Q

What are some risk factors for hiatus hernia development?

A
age
pregnancy
obesity
ascites
inc intraabdominal pressure
22
Q

What are some symptoms of hiatus hernia?

A
most asymptomatic
GORD
vomiting and weight loss
bleeding and anaemia
hiccups or palpitations
swallowing difficulty
23
Q

How can hiatus hernia cause bleeding and anaemia?

A

oesophageal ulceration

24
Q

How can hiatus hernia cause hiccups?

A

irritating the diaphragm

25
Q

How can hiatus hernia cause palpitations?

A

irritating the pericardium

26
Q

What is the gold standard investigation of hiatus hernia?

A

oesophagogastroduodenoscopy (OGD)

27
Q

What are the two parts of surgically managing a hiatus hernia?

A

crucroplasty (move hernia to abdomen and make hiatus smaller)

fundoplication (wrap fundus around LOS to strengthen it)

28
Q

Where are peptic ulcers most commonly found?

A

lesser curvature of prox stomach

proximal duodenum

29
Q

What protects the stomach against peptic ulcers?

A

mucosa is protected by mucous and bicarbonate ion release

30
Q

Which factors can damage the mucosa leading to peptic ulcer development?

A

NSAIDs

H pylori

31
Q

How do NSAIDS cause peptic ulcers?

A

inhibit prostaglandins so glycoprotein, mucus + phospholipid secretion is reduced

32
Q

What is triple therapy?

A

7 days of PPI, amoxicillin and clarithromycin to treat h pylori

33
Q

How can h pylori be identified?

A

Carbon-13 urea breath test
Serum antibodies to H. pylori
Stool antigen test

34
Q

What does h pylori cause?

A

duodenal ulcers
gastric adenocarcinoma
atrophic gastritis
unclear link to GORD

35
Q

50y/o M with 3wk hx of fresh haematemesis, 3 months of early satiety + epigastric pain

A

gastric cancer