Gastric Problems Flashcards
What is gastritis
Inflammation of the stomach lining
Dx histologically after OGD
What causes gastritis
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
What is H.pylori and how does it cause gastritis
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
What are the S+S of gastritis
How do you differentiate from cancer
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
When does gastritis tend to lead to bleeding
Impaired coagulation
Medication - anti platelet / coagulant
How do you Dx gastritis
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
How do you treat gastritis
Treat cause Avoid irritant Antacids / milk will improve Triple therapy for H.pyolri - Antibiotics x2 - PPI H2 blocker - not always needed
What are the complications of gastritis
Polyp Tumour Bleeding B12 deficiency in autoimmune Obstruction Perforation
How does urea breath test work and CLO test
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
What antibiotics in gastrits / H.pylori
Clarithromycin 500mg
Amoxicillin 1g
Repeat scope in 3 months and test for H.pylori
If -ve = PPI +H2 for 4 weeks
What is the autoimmune attack in gastritis
Ab against parietal cells and intrinsic factor binding sites
Lose intrinsic factor = B12 deficient
Less acid production
Lymph infiltration + fibrosis
Where does peptic ulceration affect
Lower oesophagus
Body and Antrum
Duodenum - most common
What causes peptic ulcers
Imbalance between acid secretion and mucosal barrier
What is associated with peptic ulcers
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
What are the symptoms of peptic ulcers
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)
What are the RF for peptic ulceration / things that can increase acid
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
How do you diagnose peptic ulcer
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
How do you investigate perforation
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
How do you treat peptic ulceration
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
How do you treat bleeding in peptic ulcers and what do you give after
ABCE Endoscopy PPI after Inject adrenaline Clip Thermal contact Haemospray Angiography with embolisation
What are the complications of peptic ulcer
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
What is gastric outlet obstruction
Any disease that produces a mechanical impediment to gastric emptying
Essentially pyloric stenosis but in adult
What causes gastric outlet obstruction
Stricture Ulcer Cancer Polyps Hiatus hernia Pyloric stenosis (congenital)
What are the symptoms of pyloric stenosis
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
How do you diagnose gastric outlet obstruction
Upper GI endoscopy
Bloods - low Cl, Na, K, renal impairment
Metabolic alkalosis
How do you treat gastric outlet obstruction
Endoscopic balloon dilatation
Surgery
Treat electrolyte / fluid replace
What are the complications of gastric outlet obstruction
Dehydration
Renal impairment
Metabolic alkalosis
Risk of aspiration pneumonia
What do you do if symptoms of gastritis persist
Re-endoscope
Retest H.pylori
Consider Ddx
What do you do for perforation of ulcer
Watch and wait
Ax
NBM
Surgery
What is the Ddx of peptic ulcer
Gastric cancer Pancreatitis Gall stones MI Chest infection Aneurysm GORD
What is most common ulcer
Duodenal
- pain relieved by eating
What is more common ulcer perforation or gall bladder
Perforation
What does it predispose you to
Gastric cancer
Can can H.pylori also cause
Peptic ulceration = most common
Gastric cancer
Gastritis
MALT
What must you do before endoscopy
Stop PPI / H2 antagonist as can hide
Make sure no Ax previous month
What do you do after treatment
Repeat scope in 3 months
Test for H.pylori
What suggests perforation / haemorrhage of ulcer
Severe persistent back pain
Sudden onset
What causes haemorrhage
Ulcer eroding artery
Gastric
Pain worse with eating
Duodenal
Pain relieved by eating as neutralised
What do you do if prescribing NSAID in elderly
Prescribe with omeprazole
What is CI in perforation
Endoscopy as damage further
What artery is eroded
Gastroduodenal
What is pernicious anaemia
Autoimmune attack on gastric parietal and intrinsic factor
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
What is associated
Blood group A Thyroid DM Coeliac Addison
How do you Dx
Megaloblastic microcytic
Ab intrinsic factor = diagnostic
Rx
IM b12
Folic acid
Risk
Predispose to gastric cancer
How do you treat MALT lymhpoma
Eradicate H.pylori
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
What is good marker if patient sick
Lactate
If smoker / alcohol + sudden onset abdo pain
Think perforated ulcer
Pancreatitis
What is a good screener upper GI bleed
Urea
