Gastric Problems Flashcards

1
Q

What is gastritis

A

Inflammation of the stomach lining

Dx histologically after OGD

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2
Q

What causes gastritis

A

Autoimmune

H.pylori

Chemical 
Drugs - NSAIDs / cocaine / smoking
CMV infection  
Alcohol
Bile reflux = inflammation 
Hernia 
Stress - surgery / burns / often in ITU patients (put patients on PPI) 
Chron's
RT
Coeliac
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3
Q

What is H.pylori and how does it cause gastritis

A

H.pylori = gram -ve bacteria which lives in the stomach
Secretes urease which splits urea into NH4 + HCO3
HCO3 stimulates stomach acid to be produced

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4
Q

What are the S+S of gastritis

How do you differentiate from cancer

A

Dyspepsia
Burning stomach pain (worse after eating and better NBM)
N+V
Early satiety
Bleeding or ulcer formation if lining worn away
Iron deficiency anaemia if bleeding
Pernicious anaemia due to lack of intrinsic
NO WEIGHT LOSS
SYSTEIMCALLY WELL

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5
Q

When does gastritis tend to lead to bleeding

A

Impaired coagulation

Medication - anti platelet / coagulant

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6
Q

How do you Dx gastritis

A

Stool test looking for infection / blood
Anaemia investigations
Urea breath test / stool test for H.pylori
Endoscopy + biopsy - rapid urea test CLO for H.pylori
Barium swallow

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7
Q

How do you treat gastritis

A
Treat cause 
Avoid irritant 
Antacids / milk will improve 
Triple therapy for H.pyolri
- Antibiotics x2
- PPI 
H2 blocker - not always needed
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8
Q

What are the complications of gastritis

A
Polyp
Tumour
Bleeding
B12 deficiency in autoimmune 
Obstruction 
Perforation
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9
Q

How does urea breath test work and CLO test

A

Urea split by urease into HCO3+NH4
CO2 is detected

Small biopsy of mucosa taken and urea added, if H.plyroi present it produces urease which converts urea to ammonia which makes it turn alkali

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10
Q

What antibiotics in gastrits / H.pylori

A

Clarithromycin 500mg
Amoxicillin 1g
Repeat scope in 3 months and test for H.pylori
If -ve = PPI +H2 for 4 weeks

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11
Q

What is the autoimmune attack in gastritis

A

Ab against parietal cells and intrinsic factor binding sites
Lose intrinsic factor = B12 deficient
Less acid production
Lymph infiltration + fibrosis

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12
Q

Where does peptic ulceration affect

A

Lower oesophagus
Body and Antrum
Duodenum - most common

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13
Q

What causes peptic ulcers

A

Imbalance between acid secretion and mucosal barrier

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14
Q

What is associated with peptic ulcers

A

H.pylori - stimulate acid production and also breakdown protective layer
Eradication will heal 90%
Increased acid = duodenal
Inflammatory response = gastric

NSAID / steroid - suppress prostaglandin synthesis leading to inflammation
Prescribe omeprazole if not CI with NSAID in elderly
Other drugs CAN CAUSE - SSRI / biphosphonates

Zollinger Ellison Syndrome
= Gastric secreting pancreatic tumour causes poor healing of duodenal ulcer
Associated MEN
Diarrhoea

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15
Q

What are the symptoms of peptic ulcers

A
Epigastric / back pain
Nocturnal hunger pain 
Pain relieved by eating / antacids = duodenal ulcer as neutralised 
Pain worse on eating / 30 mins after = gastric 
N+V
Dyspepisa 
Iron deficiency anaemia 
Weight loss 
Fat intolerance
Haematemesis 
Melena
Anorexia
Haematochezia - fresh 
No vomiting (differentiate from pancreatitis)
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16
Q

What are the RF for peptic ulceration / things that can increase acid

A
H.PYLORI
NSAIDs
Smoking = biggest RF
Alcohol
SSRI
Steroid
Biphosphonate 
Caffiene 
Zollinger Ellison Syndrome 
Delayed gastric emptying 
Stress - surgery / burns 
Spicy food
Crohn's rare
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17
Q

How do you diagnose peptic ulcer

A

Stool test or urea breath test for H.pylori = 1st line

If persistent dyspepsia following eradication
Endoscopy
Barium swallow
Measure serum gastric conc when of PPI for Zollinger Ellison Syndrome

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18
Q

How do you investigate perforation

A
Hx + exam
Treat as acute abdomen 
Blood test inc lactate on VBG
Lactate elevated 
CXR - small air (large if colonic)
CT or laparoscopy after to define 
Endoscopy = DAMAGE FURTHER SO DON'T
Gastrograff (oral contrast study) to see if perforated ulcer has healed if no surgical Rx as will see dye
Don't alway need to Rx
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19
Q

How do you treat peptic ulceration

A
H.pylori eradication
Treat as reflux if no H.pyolri (PPI + H2R until healed) 
Stop NSAID / smoking = biggest advice 
Alternative pain relief 
Avoid caffeine / alcohol 
Surgery if perforation
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20
Q

How do you treat bleeding in peptic ulcers and what do you give after

A
ABCE
Endoscopy
PPI after 
Inject adrenaline
Clip
Thermal contact
Haemospray
Angiography with embolisation
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21
Q

What are the complications of peptic ulcer

A

Bleeding causing haemorrhage / haematemesis
Anaemia
Perforation = severe pain + back pain of sudden acute onset
Peritonitis if perforation
Fibrosis
Gastric outlet obstruction / pyloric stenosis
Polyps
Tumour

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22
Q

What is gastric outlet obstruction

A

Any disease that produces a mechanical impediment to gastric emptying
Essentially pyloric stenosis but in adult

23
Q

What causes gastric outlet obstruction

A
Stricture
Ulcer
Cancer
Polyps
Hiatus hernia 
Pyloric stenosis (congenital)
24
Q

What are the symptoms of pyloric stenosis

A

Vomiting - no bile (clear fluid from saiva and gastric juice)
Early satiety
Distension
Weight loss
Gastric splash
Dehydration - lose H and Cl in vomit (hypochloraemic hypokalaemia alkalosis)
Renal impairment

25
How do you diagnose gastric outlet obstruction
Upper GI endoscopy Bloods - low Cl, Na, K, renal impairment Metabolic alkalosis
26
How do you treat gastric outlet obstruction
Endoscopic balloon dilatation Surgery Treat electrolyte / fluid replace
27
What are the complications of gastric outlet obstruction
Dehydration Renal impairment Metabolic alkalosis Risk of aspiration pneumonia
28
What do you do if symptoms of gastritis persist
Re-endoscope Retest H.pylori Consider Ddx
29
What do you do for perforation of ulcer
Watch and wait Ax NBM Surgery
30
What is the Ddx of peptic ulcer
``` Gastric cancer Pancreatitis Gall stones MI Chest infection Aneurysm GORD ```
31
What is most common ulcer
Duodenal | - pain relieved by eating
32
What is more common ulcer perforation or gall bladder
Perforation
33
What does it predispose you to
Gastric cancer
34
Can can H.pylori also cause
Peptic ulceration = most common Gastric cancer Gastritis MALT
35
What must you do before endoscopy
Stop PPI / H2 antagonist as can hide | Make sure no Ax previous month
36
What do you do after treatment
Repeat scope in 3 months | Test for H.pylori
37
What suggests perforation / haemorrhage of ulcer
Severe persistent back pain | Sudden onset
38
What causes haemorrhage
Ulcer eroding artery
39
Gastric
Pain worse with eating
40
Duodenal
Pain relieved by eating as neutralised
41
What do you do if prescribing NSAID in elderly
Prescribe with omeprazole
42
What is CI in perforation
Endoscopy as damage further
43
What artery is eroded
Gastroduodenal
44
What is pernicious anaemia
Autoimmune attack on gastric parietal and intrinsic factor
45
What are the symptoms
``` Sx of anaemia Lethary Weakness SOB Pallor Atrophic glottis ``` Neuro Sx due to degeneration of spinal cord Paresthesia Neuropathy ``` Other Mild jaundice Retinal haemorrhage Mild splenomegaly Diarrhoea ```
46
What is associated
``` Blood group A Thyroid DM Coeliac Addison ```
47
How do you Dx
Megaloblastic microcytic | Ab intrinsic factor = diagnostic
48
Rx
IM b12 | Folic acid
49
Risk
Predispose to gastric cancer
50
How do you treat MALT lymhpoma
Eradicate H.pylori
51
How do you investigate perforation
Treat as acute abdomen - CXR first to look for free air - Once free air Dx then enough for radiology to do CT to show cause
52
What is good marker if patient sick
Lactate
53
If smoker / alcohol + sudden onset abdo pain
Think perforated ulcer | Pancreatitis
54
What is a good screener upper GI bleed
Urea