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AY Gastrointestinal > Gastric Disease & microbiology > Flashcards

Gastric Disease & microbiology Flashcards

1
Q

3 types of gastric cancer

A

Adenocarcinoma (H. pylori)
Lymphoma
GISTs

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2
Q

Clinical presentation of gastric cancer

A 
Dyspepsia 
Abdominal pain 
Vomiting 
Dysplasia 
Early satiety 
Weight loss
Abdominal mass
Jaundice 
Paraneoplastic syndromes
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3
Q

Physical examination findings of gastric cancer

A

Weight loss
Lymph nodes
Abdominal mass

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4
Q

Investigation for.suspected gastric cancer

A

Endoscopy & biopsy

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5
Q

Imagin studies for gastric cancer

A

Barium meal

CT scan

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6
Q

Alarm features for gastric/oesophageal cancer

A 
> 55 years of age 
Dysphasia 
Evidence of GI blood loss 
Persistent vomiting 
Unexplained weight loss 
Upper abdominal mass 
Anaemia
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7
Q

First line treatment for gastric cancer

A

Surgery

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8
Q

Treatment of inoperable gastric cancer

A

Radiotherapy

Chemotherapy

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9
Q

Contraindications for surgery in gastric cancer patients

A

Widely metastatic disease
Malignant ascites
Brief life expectancy

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10
Q

5 year survival rate for gastric cancer

A

15%

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11
Q

What is dyspepsia?

A

Disordered digestion usually associate with pain or discomfort in the lower chest abdomen after eating

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12
Q

Causes of dyspepsia

A 
Non-ulcer and dyspepsia 
Oesophagitis/GORD 
Duodenal/gastric ulcer 
Gastric malignancy 
Duodenitis 
Gastritis
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13
Q

Risk factors for gastric ulcers

A 
Smoking 
Alcohol 
Age 
NSAIDs 
GORD
Stress
Delayed gastric emptying
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14
Q

Symptoms of gastric ulcers

A

Epigastric pain related to meals
Relieved by antacids
Weight loss

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15
Q

Investigation for peptic ulcer

A

Endoscopy & biopsy

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16
Q

How do you check healing of peptic ulcer?

A

Further endoscopy

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17
Q

How long after treating the cause of a peptic ulcer do you review the patient?

A

4 weeks

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18
Q

If after 4 weeks the peptic ulcer is still there what do you do next?

A

Test for H. pylori

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19
Q

What is the treatment to eradicate H. pylori?

A

PPI
Amoxicillin (metronidazole if allergic)
Clarythromycin

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20
Q

If a peptic ulcer shows no improvement but the H. pylori test is negative what is the next step of treatment?

A

PPIs (omeprazole) or H2 blockers (ranitidine) for 4 weeks

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21
Q

What is gastroparesis?

A

Delayed gastric emptying not caused by obstruction

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22
Q

Symptoms of gastroparesis

A 
Bloating 
Feeling of fullness 
Vomiting 
Weight loss 
Abdominal pain
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23
Q

In surgery for gastric cancer when is a partial and total gastrectomy performed?

A

Total gastrectomy for proximal lesions

Partial gastrectomy for distal lesions

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24
Q

What are causes of acute gastritis?

A

Trauma
Chemicals
Burns

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25
What are the 3 main causes of chronic gastritis?
Chemical Bacterial Autoimmune
26
What happens in autoimmune gastritis?
Antibodies attack parietal cells and intrinsic factor and can lead to pernicious anaemia
27
What is the most common bacteria that causes gastritis?
H. Pylori
28
Where does H. pylori like to reside?
Between the epithelial cell surface and mucosal barrier here it can cause inflammation
29
Which chemicals are the most common cause of chemical gastritis?
NSAIDs Bile reflux Alcohol
30
How does chemical insult affect the stomach?
Destroys the lipid bilayer causing inflammation, hyperplasia and ulcers
31
What is food poisoning?
Illness caused by eating food contaminated with micro-organisms, toxins, poisons etc
32
What are the important questions in the history when thinking of food poisoning?
``` Diarrhoea (blood? Colour? Quantity?) Travels? Suspect food? Anyone else I'll? Time from ingestion of suspect food? Age of patient? Underlying medical problems? ```
33
How long is a short incubation period?
1-6 hours
34
What bacteria have a short incubation time?
Staph aureus | Bacillus cereus
35
What is the more common presentation of short incubation food poisoning?
Abdominal pain Vomiting (acts on vomiting centre in brain)
36
How long is a medium intubation period for bacteria in food poisoning?
12-48 hours
37
What bacteria have a medium intubation period?
Salmonella | Cl perfrigens
38
What is a common presentation of medium/long intubation food poisoning?
Diarrhoea - often bloody | Toxin in gut
39
How long is a long intubation period for bacteria in food poisoning?
2-14 days
40
What bacteria have long intubation periods?
Campylobacter | E. coli 0157
41
How is bacteria identified in food poisoning?
Stool culture
42
Clinical presentation of campylobacter?
Pain PR blood Fever
43
Treatment of campylobacter
Ciprofloxacin/erythromycin
44
What is the intubation period of campylobacter?
16-48 hours
45
What is the intubation period of salmonella?
12-48 hours
46
Clinical presentation of salmonella
Diarrhoea and vomiting Blood Fever
47
Treatment of salmonella
Ciprofloxacin
48
What is the most common presenting complaint with E. coli 0157?
Bloody diarrhoea
49
Which 2 patient groups are most at risk of complications of E. coli 0157?
Children & the elderly
50
E. coli can be transmitted from person to person. True/False.
True. | E. coli can be transmitted through direct or indirect contact.
51
What is the incubation period of E. coli 0157?
1-14 days
52
What dangerous toxin do some strains of E. coli produce?
Verotoxin
53
What does verotoxin do?
Binds to receptors on renal cells, RBC & others inhibiting protein synthesis and causes cell death
54
What is haemolytic uraemic syndrome?
A condition in which sudden rapid destruction of red blood cells causes acute renal failure due partly to obstruction of small arteries in the kidneys. Causes a reduction in the number of platelets lead to haemorrhage.
55
Clinical presentation of HUS
``` Abdominal pain Fever Pallor Petechaie Oliguria Bloody diarrhoea (may develop after diarrhoea has stopped) ```
56
Blood results of HUS
High white cells Low platelets Low Hb Red cell fragments
57
Investigations for HUS
``` Stool culture FBC Urine U+E's Lactate dehydrogenase ```
58
What do you not give to patients with HUS?
NO antibiotics NO anti-motility agents NO NSAIDs
59
What virus is most common in kids
Rotavirus
60
Clinical presentation of rotavirus
Moderate fever First vomiting then diarrhoea Not bloody
61
Treatment for rotavirus
Self limiting | Lasts a week
62
How to diagnose rotavirus?
PCR of faeces
63
Can norovirus be transmitted from person to person?
Yes
64
Symptoms of norovirus
D&V - explosive and sudden | Stomach cramps
65
How long is the incubation period for norovirus?
66
Investigations to diagnose norovirus
PCR of stool | PCR of vomit
67
Treatment of norovirus
Usually self limiting | Hydration is key
68
What can C. diff be a side effect of?
Antibiotic treatment
69
Antibiotics that cause C. diff
Cephlaosporins Clindamycin PeniCillins
70
Investigation of C. diff
Stool culture FBC CRP
71
Treatment of non severe C. diff
Metronidazole 400mg (10 days)
72
Treatment of severe C. diff
Vancomycin +/- metronidazole
73
Contact precautions of infection
``` Single room Hand washing Single use items Apron Gloves ```
74
3 types of travel related diarrhoea
Amoebiasis Giardiasis Cryptosporidosis
75
Treatment of travellers diarrhoea
Fluids up to 93 hours | Single dose of ciprofloxacjn and short term anti-diarroheals azithromycin if resistant to ciprofloxacin
76
How to diagnose amoebiasis?
Examination of hot stool for ova & cysts
77
Treatment of amoebiasis
Metronidazole
78
Where can amoebiasis cause abscesses?
Liver
79
How to diagnose giardiasis?
Examination of stools for ova & cysts but more accurately by duodenum aspiration
80
Treatment of giardiasis
Metronidazole
81
How to diagnose Cryptosporidosis?
Duodenal aspirate | Stool
82
Treatment of Cryptosporidosis?
Supportive | Antimicrobials virtually ineffective

AY Gastrointestinal (21 decks)

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