GASTRIC DISEASE Flashcards
what type of stomach cancer is most common?
adenocarcinoma from gastric mucosa
What are the risk factors for gastric cancer?
male
inc age
H pylori (6x risk)
smoking alcohol
How can h pylori infection result in cancer?
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.
What kind of bacteria is h pylori?
its a gram negative helical bacteria
How does gastric cancer present?
often vague and non-specific dyspepsia dysphagia early satiety vomiting melaena non-specific symptoms (in late disease)
What are some signs of gastric cancer on examination? at what stage do they appear?
mass in epigastrium - late in disease
palpable left supraclavicular node (virchow node) - metastatic abdominal malignancy
How should ?gastric cancer be investigated?
urgent OGD + biopsy
What biopsies should be taken for query gastric cancer?
histology
CLO test for h pylori
HER2/neu protein expression for targeted therapies
What further investigation is needed to plan treatment for a confirmed gastric cancer?
CT chest abdo pelvis
staging laparoscopy for peritoneal mets
How is gastric cancer managed?
total or subtotal gastrectomy where oesophagus joins small bowel directly + chemotherapy
How can gastric cancer confined to the mucosa be treated?
endoscopic mucosal resection
Give some side effects of gastrectomy
death
anastamostic leak
dumping syndrome
vit B12 deficiency
What is dumping syndrome?
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)
What red flag symptoms require urgent upper endoscopy for query malignnacy?
Patients with dysphagia
Any patient >55yrs with weight loss and upper abdominal pain, dyspepsia, or reflux
Describe surgical intervention for GORD
fundoplication, whereby the gastro-oesophageal junction and hiatus are dissected and the fundus wrapped around the GOJ, recreating a physiological lower oesophageal sphincter
What is a hiatus hernia?
where an abdominal organ protrudes through the oesophageal hiatus
What are the 2 types of hiatus hernia?
sliding
rolling
What is a sliding hiatus hernia?
most common type
GOJ, oesophagus + cardia of stomach move upward into thorax
What is a rolling hiatus hernia?
gastric fundus moves into thorax but GOJ does not so a bubble forms, “true hernia”
Which type of hiatus hernia is more prone to strangulation and volvulus?
rolling
What are some risk factors for hiatus hernia development?
age pregnancy obesity ascites inc intraabdominal pressure
What are some symptoms of hiatus hernia?
most asymptomatic GORD vomiting and weight loss bleeding and anaemia hiccups or palpitations swallowing difficulty
How can hiatus hernia cause bleeding and anaemia?
oesophageal ulceration
How can hiatus hernia cause hiccups?
irritating the diaphragm
