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Y4: Gastroenterology > Gastric / duodenal ulcer disease > Flashcards

Gastric / duodenal ulcer disease Flashcards

1
Q

Describe the forces of attack against the stomach?

A
  • Acid
  • Pepsin
  • Helicobacter pylori
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2
Q

Describe the forces of defence of the stomach?

A
  • Cell turnover
  • Mucus secretion
  • Mucosal blood flow
  • Bicarbonate secretion
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3
Q

Describe the symptoms of dyspepsia and peptic ulcer disease?

A
  • Epigastric pain related to:
    • Hunger
    • Specific foods
    • Time of the day
    • Heartburn (retrosternal pain)
  • ALARM symptoms
    • Anaemia (IDA), Loss of weight, Anorexia, Recent onset, Melaena, Swallowing difficulty
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4
Q

Describe some tests for H. pylori?

A
  • Invasive
    • CLO test (campylobacter-like organism)
    • Histology
    • Culture
  • Non-invasive
    • Urea breath test (most accurate non-invasive test)
    • Stool antigen
    • Serology
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5
Q

Describe the management of someone with dyspepsia/peptic ulcer disease who tests positive for H. pylori?

A
  • PPI + 2 antibiotic combination
    • eg Lansoprazole, clarithromycin, amoxicillin
  • If negative for H. pylori: give acid suppression alone
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6
Q

Risk factors for a duodenal ulcer?

A
  • Major:
    • H. pylori
    • Drugs: NSAIDs, steroids, SSRI
  • Minor:
    • Increased gastric acid secretion
    • Blood group O
    • Smoking
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7
Q

Symptoms of duodenal ulcer?

A
  • Asymptomatic
  • Epigastric pain (relieved by antacids)
  • +/- weight loss
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8
Q

Signs of duodenal ulcer?

A

Epigastric tenderness

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9
Q

Describe the diagnosis of a duodenal ulcer?

A
  • Upper GI endoscopy
  • Test for H. pylori
  • If Zollinger-Ellison is suspected:
    • Test gastrin secretions when not taking PPIs
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10
Q

Differentials for a duodenal ulcer?

A
  • Duodenal Crohn’s
  • TB
  • Lymphoma
  • Pancreatic cancer
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11
Q

Treatment for Duodenal ulcer?

A
  • PPI eg Lansoprazole
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12
Q

Describe Gastric ulcers?

A
  • Mainly in the elderly
  • Risk factors: H. pylori, smoking, NSAIDs, reflux
  • Symptoms: Asymptomatic/epigastric pain +/- weight loss
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13
Q

Tests for Gastric ulcers?

A
  • Upper GI endoscopy (exclude malignancy)
  • Multiple biopsies from ulcer rim and base
    • Histology
    • H. pylori tests
  • Upper GI endoscopy after 8 weeks
    • (exclude malignancy and confirm healing)
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14
Q

Risk factors for Gastritis?

A
  • Alcohol
  • NSAIDs
  • H. pylori
  • Reflux/hiatus hernia
  • Granulomas (Crohns, sarcoidosis)
  • Zollinger-Ellison syndrome
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15
Q

Symptoms of Gastritis?

A
  • Epigastric pain
  • Vomiting
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16
Q

Descrbie the treatment for dyspepsia and peptic ulcer disease?

A
  • Lifestyle
    • Reduce alcohol and tobacco
  • H. pylori eradication (triple therapy)
  • Drugs to reduce acid
    • PPIs (lansoprazole
    • H2 blockers (ranitidine)
  • Drug-induced ulcers
    • Stop drugs + PPI
  • Surgery
17
Q

Complications of dyspepsia and peptic ulcer disease?

A
  • Bleeding
  • Perforation
  • Malignancy
  • Reduced gastric outflow
18
Q

Describe Functional (non-ulcer) dyspepsia?

A
  • H. pylori eradiation if positive result may help
  • PPIs
  • Psychotherapy
  • Amitriptyline
19
Q

Describe the management pathway for dyspepsia?

A
20
Q

Describe Zollinger-Ellison syndrome?

A
  • Peptic ulcers with gastrin secreting adenoma (gastrinoma)
  • Adenoma usually in the pancreas
  • Associated with MEN1
21
Q

Symptoms of Zollinger-Ellison syndrome?

A
  • Abdominal pain
  • Dyspepsia
  • Chronic diarrhoea (inactivation of pancreatic enzymes => steatorrhoea)
22
Q

Tests for Zollinger-Ellison syndrome?

A
  • Fasting serum gastrin level
    • Measure on 3 different days
  • Localize/stage the adenoma:
    • Somatostatin receptor scintigraphy
    • Endoscopic US
    • CT
23
Q

Treatment for Zollinger-Ellison syndrome?

A
  • High-dose PPIs (omeprazole)
    • Dose based on intra-gastric pH
  • If well differentiated:
    • Somatostatin analogues
  • Chemotherapy can also be used
24
Q

What is pictured here?

A
  • OctreoScan
    • Patient has metastatic MEN1 gastrinoma
  • Thin arrow: Solitary hepatic metastatic deposit
  • Thick arrow: Gastric neuroendocrine tumour
25
Q

Describe Menetrier’s disease?

A
  • Giant gastric mucosal folds (up to 4cm high)
  • Increased mucosal thickness
  • Hypochlorhydria
  • Protein losing gastrophy
  • Causes: CMV, strep, H. pylori
26
Q

Difference between peptic ULCERS and erosions?

A

Erosions do not penetrate the muscularis mucosae

27
Q

Describe H. pylori?

A
  • Gram negative
  • Spiral shaped
  • Has flagellae making it motile
28
Q

Side effects of H. pylori eradication therapy?

A
  • N/V
  • Diarrhoea
  • Headache
29
Q

Indications for surgery in peptic ulcer disease?

A
  • Emergency
    • Perforation
    • Haemorrhage
  • Elective
    • Gastric outflow obstruction
    • Persistent ulceration despite medical therapy
      *
30
Q

Surgery of choice for peptic ulcer disease?

A

Partial gastrectomy with Billroth I anastomosis

Y4: Gastroenterology (14 decks)

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