Gastric Disorders Flashcards
What is dyspepsia?
Pain or discomfort in upper abdomen - retrosternal pain, nausea, vomiting, bloating, fullness, early satiety and heartburn Very common (80%) of people have no serious underlying pathology
What are various causes of dyspepsia?
Peptic Ulcer
Gastritis
Non-ulcer Dyspepsia (basically Idiopathic Dyspepsia)
Gastric Cancer
IBS
Colonic Cancer
Coeliac Disease
Gallstones
Pancreatic disease
Liver disease/disorders
Drugs
Systemic Disease
What is gastritis and what are the different types?
Inflammation in gastric mucosa
A - Autoimmune (parietal cells)
B - Bacterial (H Pylori)
C - Chemical (Bile/NSAIDs)
What are some causes of nausea/vomiting?
Immediately after eating - psychogenic
1 hour+
- Pyloric obstruction or motility disorders (diabetes, post gastrectomy)
12+
- obstruction etc.
Causes
- drugs
- pregnancy
- migraine
- cyclical vomiting syndrome
- alcohol
What are the ALARM symptoms?
A - Anorexia
L - Loss of Weight
A - Anaemia (Fe deficiency)
R - Recent onset >55 years or persistent
M - malaena/haematemesis or Mass
Also, swallowing problems/dysphagia
What investigations might be done in dysphagia?
History/Examination are key
- drug history
Bloods - FBC, Ferritin, LFTs, U&Es, Calcium, Coeliac serology/serum IgA
Upper GI endoscopy if ALARM or >55
- refer to GI if persistent despite Pylori therapy
What drugs typically may cause dysphagia?
NSAIDs
Steroids
Bisphosphonates
Calcium antagonists
Nitrates
Theophylline
How is H Pylori diagnosed?
Non-invasive
- serology (IgG against pylori)
- 13C/14C urea breath test
- stool antigen test - ELISA - (needs PPI cessation for 2w)
Invasive
- endoscopy
> histology (gastric biopsies stained for bacteria)
> culture of biopsy
> rapid slide urease test (CLO)
Treat symptomatically if all negative
What are some differential diagnoses of dysphagia?
Dyspepsia alone
Gastritis
Peptic Ulcer
Gastric Outlet Obstruction
Gastric Cancer
Helicobacter Pylori details?
Gram -ve
Spiral shaped
Microaerophilic
Flagellated
Can only colonise gastric type mucosa
Does not penetrate epithelial layer
Evokes immune response in underlying mucosa, host genetics dependent
H Pylori Outcomes?
Asmyptomatic
Chronic Gastritis
Chronic atrophic gastritis
Intestinal metaplasia
Ulcer (Gastric, Duodenal)
Gastric Cancer
MALT Lymphoma
Risk factors/causes for Peptic Ulcer?
H Pylori
NSAIDs
Smoking
Rarely
- Zollinger-Ellison Syndrome
- Hyperparathyroidism
- Crohn’s
Symptoms/signs of peptic ulcer?
Epigastric pain/tenderness
Nausea/vomiting
Weight loss/Anorexia
Haematemesis/malaena
Nocturnal/hunger pain (more common in DU)
Back pain (suggests penetration of posterior DU)
Treatment of peptic ulcer?
PPI or H2 receptor antagonist (ranitidine)
Stop NSAIDs or ensure protective agents
Surgery only in complicated DU
H Pylori treatment (triple therapy 7 days)
- clarithromycin
- amoxicillin/metronidazole/tetracycline
- PPI
Possible complications of peptic ulcer?
Acute bleeding (haematemesis/malaena)
Chronic bleeding (Anaemia)
Perforation
Fibrotic stricture
Gastric outlet obstruction
Symptoms/signs of gastric outlet obstruction
Vomiting - lacks bile, fermented foodstuffs
Early satiety, abdominal distention, weight loss, gastric splash
Dehydration
Metabolic alkalosis
Low Cl, Na, K in bloods, renal impairment
Diagnosis and treatment of gastric outlet obstruction?
Upper GI endoscopy
Identify cause - stricture, ulcer, cancer
Treated with endoscopic balloon dilatation, surgery
What are the different types of bariatric surgery?
Restrictive
Malabsorptive
Combination
What are some examples of bariatric surgery?
Laparoscopic adjustable gastric banding
Laparoscopic gastric bypass
Laparoscopic sleeve gastrectomy
Pros/cons of adjustable gastric band?
+
Minor surgery
Reversible/adjustable
Low risk of complications
Mortality 0.1%
-
Requires implanted device
Easy to ‘cheat’
Risk of prolapse/slippage
15% require revisional surgery
Pros/cons of Gastric Bypass
+
Quick and dramatic weight loss
Pedigree
Dumping syndrome
-
More invasive
Malabsorptive component requires lifelong supplements
More complex if requires revision
Mortality 0.5%
Sleeve gastrectomy pros/cons
+
Good medium term outcomes
No dumping syndrome
No small bowel manipulation
No foreign body
-
More invasive
Long staple line (bleeding/leak risk)
Short pedigree
Mortality 0.4%
Complications of bariatric surgery?
Anastomotic leak
DVT/PE
Infection
Malnutrition
Vitamin/mineral deficiencies
Hair loss
Excess skin
