Gastric Pathology Flashcards
How does a DU present? Does anything improve/worsen these symptoms?
50% asymptomatic
Epigastric pain: WORSE before meals, at night, BETTER eating, drinking milk
Epigastric tenderness
How does a GU present? Does anything improve/worsen these symptoms?
Epigastric pain: WORSE eating, BETTER antacids
Weight loss
Where are GU commonly found?
Lesser curve
Which type of ulcers are the most common?
Duodenal
What are the RFs for peptic ulcers?
H.Pylori
Smoking
NSAIDs
Alcohol
How are peptic ulcers investigated?
1) Bloods: FBC (↓Hb)
2) Non-invasive H.Pylori test: Carbon-12 urea breath test/stool antigen= DIAGNOSTIC
2) Invasive H.Pylori test: CLO at endoscopy
3) Upper endoscopy: Exclude malignancy, take biopsies & brushings
What procedure needs to be carried post-treatment of peptic ulcers?
Repeat endoscopy for gastric ulcers due to risk of malignant conversion
How is a H.Pylori induced ulcer treated?
Triple therapy 14days - Full dose PPI -Amoxicillin?Metronidazole -Clarithromycin Check for eradication of H pylori 1 month after the end of therapy
How is an NSAID induced ulcer treated?
STOP NSAID
PPI-ulcer should heal in 8weeks
What are the complications of peptic ulcer?
Perforation
Haematemesis- erosion into gastrodudenal artery
Pyloric stenosis
What is achalasia?
Degeneration of myenteric plexus
How does achalasia occur?
Impaired function of oesophageal smooth muscle
Failure of LOS to relax
Functional stenosis or oesophageal strictures
↓motility and dysphagia
How does achalasia present?
Dysphagia: Solids > Fluids
Regurg & reflux
Chest pain: Retrosternal
LATE: Nocturnal cough, aspiration
How is achalasia investigated?
1) Fluoroscopy w/barium swallow: Oesophageal dilatation then stricture (BIRD BEAK SIGN) stasis of barium swallow
MANOMETRY! 90%
CXR: Dilated oesophagus, gastric air bubble small
What will be seen on manometry for achalasia?
High resting LOS pressure
Incomplete relaxation on swallowing
Absent peristalsis
How is achalasia managed?
CCB + Nitrate
Endoscopic balloon dilatation → Post-op PPI
Botox injection
What is Plummer-Vincent Syndrome?
Young women
Sx: Dysphagia + anaemia + oesophageal strictures
What are the causes of gastritis?
OH- NSAIDs H.Pylori (Atrophic gastritis) Reflux/ hiatus hernia CMV Zollinger-Ellison
How does gastritis present?
Epigastric pain Dyspepsia vomiting Haematemesis ALARM Sx
How is gastritis investigated?
H.Pylori test: Urea breath test or stool antigen
Endoscopy & biopsy: Stop PPI 2w before
How is gastritis managed?
INDUCED: Triple therapy (PPI + Amox/Met + Clarithro) for 7d
NOT INDUCED: PPI 8w then Ranitidine if no effect
What is gastritis treatment dependent on?
Whether H.Pylori induced or not