Gastric Pathology Flashcards
What is a peptic ulcer?
Imbalance between acid secretion and mucosal barrier, creating sores/break in mucosal membrane of stomach or duodenum
What is the most common ulcer in the GI tract?
Duodenal ulcers
What is the most common cause of GI bleed?
Gastric ulcer
What sex are gastric ulcers most common in?
M>F
What age group are gastric ulcers most common?
Elderly
What causes gastric ulcers?
Helicobacter Pylori infection
Drugs
Zollinger-Ellison
Alcohol and smoking
Stress ulcers
What drugs can cause gastric ulcers?
NSAIDS
SSRI
Corticosteroids
Bisphosphonates
Causes multiple ulcers
What is Zollinger-Ellison?
Excessive levels of gastrin, usually due to gastrin secreting tumour of the duodenum or pancreas (MEN1)
How do gastric ulcers present?
Epigastric pain and tenderness
- Worse at night and when eating
- Radiation to back suggests perforation
N&V
Haematemesis/coffee ground vomit, if haemorrhage
Bloating, increased while eating meal
Iron deficiency anaemia, if haemorrhage
Compare peptic and duodenal ulcer symptoms
Epigastric pain worsens at night and when eating for peptic ulcers
Epigastric pain worsens when hungry for duodenal ulcers/improves when eating
What investigations are used in gastric ulcer diagnosis?
Upper GI Endoscopy, with CLO test to assess H pylor and biopsy to exclude malignancy
Other H Pylori investigation
- Urea breath test
- Stool antigen test
Descibe the urea breath test
Breath in urea and if there is O2 detection, it shows that urea was split into CO2 and ammonia
How are gastric ulcers managed?
Stop offending drugs
If H.Pylori positive, eradication therapy
If H.Pylori negative, PPI until ulcer is healed
Endoscopy can be used for ulcer monitoring
Name complications of gastric ulcers
Gastric carcinoma
Haemorrhage
Perforation, resulting in peritonitis
Scarring and strictures, leading to narrowing of the pylorus, leading to GORD and gastric outlet obstruction
How are perforated ulcers managed?
IV fluids
Analgesia
CXR shows pneuomperitoneum
Laparotomy
What are the types of peritonitis?
Localised, caused by underlying organ inflammation
Generalised, caused by perforation
Spontaneous bacterial peritonitis, associated with ascites
How does peritonitis present?
Guarding
Rebound tenderness
Percussion tenderness
Coughing tenderness
Rigidity
What are the ALARMS symptoms?
Age over 55
Loss of weight
Anaemia
Recent onset of progressive symptoms
Masses and melaena/haematemesis
Swallowing difficulty
What is the prognosis of gastric cancer?
Poor, 5 year survival is 15%
What are the causes of gastric cancer?
Helicobacter Pylori Infection
Smoking
Diet
- High salt and nitrate
FH
Previous gastric surgery
Blood group A
How does gastric cancer present?
Dyspepsia/Epigastric pain
Weight loss
N&V
Melaena
Upper abdominal mass
Virchow’s lymph node
Dysphagia
Cachexia
What are the classic metastatic signs of gastric cancer?
Hepatomegaly
Palpable Virchow’s node, located in the left supraclavicular fossa
What investigations are used in gastric cancer diagnosis?
FBC
- Iorn deficiency anaemia
Endoscopy with multiple biopsies
Barium/contrast meal
Staging imaging/CT
What biopsy sign is seen in gastric adenocarcinoma?
Signet ring cells, the higher the number the worse the prognosis
How is gastric cancer managed?
Gastrectomy plus lymph node resection
Palliative
- Chemotherapy
- Procedures centred on relieving gastric obstruction
Name complications of a gastrectomy
B12 deficiency/subacute combined degeneration of the spinal cord
Iron deficiency anaemia
Dumping syndrome
Vitamin D deficiency
Osteoporosis
Weight loss
Increased gall stone risk
Increased gastric cancer risk
What type of bacteria is H.Pylori?
Gram negative
What enzyme does H.Pylori release and why is this clinically relevant?
Releases the enzyme urease which breaks down urea into ammonia and CO2, creating an alkaline shield
Urea breath test shows it has been split
Describe the antibiotic therapy for H.Pylori
CAP 7
Triple therapy for 7 days
Clarithromycin
Amoxicillin
(PPI)
What causes gastritis?
Autoimmune
Helicobacter Pylori infection
Chemical
What are the chemical causes of gastritis?
Alcohol
NSAIDS
Duodenal reflux
Aspirin
Name the complications of gastritis
Haemorrhage
Stomach ulcers
Stomach carcinoma
Pernicious anaemia
When should a urea breath test not be done?
Should not be done within 4 weeks of treatment with an antibacterial or within 2 weeks of a PPI
What investigation is used to check for H.Pylori eradication and when is this done?
Urea breath test 8 weeks after eradication therapy
What condition is H.pylori most associated with?
Duodenal ulcers
Give side effects of PPIs
Hyponatraemia
Hypomagnasaemia
Osteoporosis
Microscopic colitis
Clostridium difficile infection
What patients should be offered an urgent endoscopy?
Any patient with dysphagia
Upper abdominal mass consitent with stomach cancer
Patients aged over 55 with weight loss and any of the following
- Upper abdominal pain
- Reflux
- Dyspepsia
What patients should be offered a non-urgent/routine endoscopy?
Patients with haematemesis
Patients over 55 who have
- Treatment resistant dyspepsia
- Upper abdominal pain with low haemoglobin levels
- Raised platelet count with N&V, dyspepsia, reflux, weight loss etc
What is MALT lymphoma?
Lymphoma involving the mucosa-associated lymphoid tissue (MALT), frequently of the antrum of the stomach, but virtually any mucosal site can be affected
What is associated with MALT lymphoma?
H pylori infection
What is the prognosis of MALT lymphoma?
Good prognosis
How are gastric MALT lymphomas managed?
If low grade, 80% respond to H pylori eradication therapy
In high grade or atypical cases, chemo and/or radiotherapy may be required
What artery is associated with perforated gastric ulcers?
Gastroduodenal
