Gastric Disorders

Question 1

What is dyspepsia?

Answer 1

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

Question 2

What are various causes of dyspepsia?

Answer 2

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

Question 3

What is gastritis and what are the different types?

Answer 3

Inflammation in gastric mucosa
A - Autoimmune (parietal cells)
B - Bacterial (H Pylori)
C - Chemical (Bile/NSAIDs)

Question 4

What are some causes of nausea/vomiting?

Answer 4

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

Question 5

What are the ALARM symptoms?

Answer 5

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

Question 6

What investigations might be done in dysphagia?

Answer 6

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

Question 7

What drugs typically may cause dysphagia?

Answer 7

NSAIDs
Steroids
Bisphosphonates
Calcium antagonists
Nitrates
Theophylline

Question 8

How is H Pylori diagnosed?

Answer 8

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

Question 9

What are some differential diagnoses of dysphagia?

Answer 9

Dyspepsia alone
Gastritis
Peptic Ulcer
Gastric Outlet Obstruction
Gastric Cancer

Question 10

Helicobacter Pylori details?

Answer 10

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

Question 11

H Pylori Outcomes?

Answer 11

Asmyptomatic
Chronic Gastritis
Chronic atrophic gastritis
Intestinal metaplasia
Ulcer (Gastric, Duodenal)
Gastric Cancer
MALT Lymphoma

Question 12

Risk factors/causes for Peptic Ulcer?

Answer 12

H Pylori
NSAIDs
Smoking

Rarely

• Zollinger-Ellison Syndrome
• Hyperparathyroidism
• Crohn’s

Question 13

Symptoms/signs of peptic ulcer?

Answer 13

Epigastric pain/tenderness
Nausea/vomiting
Weight loss/Anorexia
Haematemesis/malaena
Nocturnal/hunger pain (more common in DU)
Back pain (suggests penetration of posterior DU)

Question 14

Treatment of peptic ulcer?

Answer 14

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

Question 15

Possible complications of peptic ulcer?

Answer 15

Acute bleeding (haematemesis/malaena)
Chronic bleeding (Anaemia)
Perforation
Fibrotic stricture
Gastric outlet obstruction

Question 16

Symptoms/signs of gastric outlet obstruction

Answer 16

Vomiting - lacks bile, fermented foodstuffs
Early satiety, abdominal distention, weight loss, gastric splash
Dehydration
Metabolic alkalosis
Low Cl, Na, K in bloods, renal impairment

Question 17

Diagnosis and treatment of gastric outlet obstruction?

Answer 17

Upper GI endoscopy

Identify cause - stricture, ulcer, cancer
Treated with endoscopic balloon dilatation, surgery

Question 18

What are the different types of bariatric surgery?

Answer 18

Restrictive
Malabsorptive
Combination

Question 19

What are some examples of bariatric surgery?

Answer 19

Laparoscopic adjustable gastric banding
Laparoscopic gastric bypass
Laparoscopic sleeve gastrectomy

Question 20

Pros/cons of adjustable gastric band?

Answer 20

+
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

Question 21

Pros/cons of Gastric Bypass

Answer 21

+
Quick and dramatic weight loss
Pedigree
Dumping syndrome

-
More invasive
Malabsorptive component requires lifelong supplements
More complex if requires revision
Mortality 0.5%

Question 22

Sleeve gastrectomy pros/cons

Answer 22

+
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%

Question 23

Complications of bariatric surgery?

Answer 23

Anastomotic leak
DVT/PE
Infection

Malnutrition
Vitamin/mineral deficiencies

Hair loss
Excess skin