Gastric Pathology

Question 1

How does a DU present? Does anything improve/worsen these symptoms?

Answer 1

50% asymptomatic
Epigastric pain: WORSE before meals, at night, BETTER eating, drinking milk
Epigastric tenderness

Question 2

How does a GU present? Does anything improve/worsen these symptoms?

Answer 2

Epigastric pain: WORSE eating, BETTER antacids

Weight loss

Question 3

Where are GU commonly found?

Answer 3

Lesser curve

Question 4

Which type of ulcers are the most common?

Answer 4

Duodenal

Question 5

What are the RFs for peptic ulcers?

Answer 5

H.Pylori
Smoking
NSAIDs
Alcohol

Question 6

How are peptic ulcers investigated?

Answer 6

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

Question 7

What procedure needs to be carried post-treatment of peptic ulcers?

Answer 7

Repeat endoscopy for gastric ulcers due to risk of malignant conversion

Question 8

How is a H.Pylori induced ulcer treated?

Answer 8

Triple therapy 14days
- Full dose PPI
-Amoxicillin?Metronidazole
-Clarithromycin
Check for eradication of H pylori 1 month after the end of therapy

Question 9

How is an NSAID induced ulcer treated?

Answer 9

STOP NSAID

PPI-ulcer should heal in 8weeks

Question 10

What are the complications of peptic ulcer?

Answer 10

Perforation
Haematemesis- erosion into gastrodudenal artery
Pyloric stenosis

Question 11

What is achalasia?

Answer 11

Degeneration of myenteric plexus

Question 12

How does achalasia occur?

Answer 12

Impaired function of oesophageal smooth muscle
Failure of LOS to relax
Functional stenosis or oesophageal strictures
↓motility and dysphagia

Question 13

How does achalasia present?

Answer 13

Dysphagia: Solids > Fluids
Regurg & reflux
Chest pain: Retrosternal
LATE: Nocturnal cough, aspiration

Question 14

How is achalasia investigated?

Answer 14

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

Question 15

What will be seen on manometry for achalasia?

Answer 15

High resting LOS pressure
Incomplete relaxation on swallowing
Absent peristalsis

Question 16

How is achalasia managed?

Answer 16

CCB + Nitrate
Endoscopic balloon dilatation → Post-op PPI
Botox injection

Question 17

What is Plummer-Vincent Syndrome?

Answer 17

Young women

Sx: Dysphagia + anaemia + oesophageal strictures

Question 18

What are the causes of gastritis?

Answer 18

OH-
NSAIDs
H.Pylori (Atrophic gastritis)
Reflux/ hiatus hernia
CMV
Zollinger-Ellison

Question 19

How does gastritis present?

Answer 19

Epigastric pain
Dyspepsia
vomiting
Haematemesis
ALARM Sx

Question 20

How is gastritis investigated?

Answer 20

H.Pylori test: Urea breath test or stool antigen

Endoscopy & biopsy: Stop PPI 2w before

Question 21

How is gastritis managed?

Answer 21

INDUCED: Triple therapy (PPI + Amox/Met + Clarithro) for 7d

NOT INDUCED: PPI 8w then Ranitidine if no effect

Question 22

What is gastritis treatment dependent on?

Answer 22

Whether H.Pylori induced or not