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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
Q

How do you diagnose gastric outlet obstruction

A

Upper GI endoscopy
Bloods - low Cl, Na, K, renal impairment
Metabolic alkalosis

26
Q

How do you treat gastric outlet obstruction

A

Endoscopic balloon dilatation
Surgery
Treat electrolyte / fluid replace

27
Q

What are the complications of gastric outlet obstruction

A

Dehydration
Renal impairment
Metabolic alkalosis
Risk of aspiration pneumonia

28
Q

What do you do if symptoms of gastritis persist

A

Re-endoscope
Retest H.pylori
Consider Ddx

29
Q

What do you do for perforation of ulcer

A

Watch and wait
Ax
NBM
Surgery

30
Q

What is the Ddx of peptic ulcer

A 
Gastric cancer 
Pancreatitis
Gall stones
MI
Chest infection
Aneurysm
GORD
31
Q

What is most common ulcer

A

Duodenal

- pain relieved by eating

32
Q

What is more common ulcer perforation or gall bladder

A

Perforation

33
Q

What does it predispose you to

A

Gastric cancer

34
Q

Can can H.pylori also cause

A

Peptic ulceration = most common
Gastric cancer
Gastritis
MALT

35
Q

What must you do before endoscopy

A

Stop PPI / H2 antagonist as can hide

Make sure no Ax previous month

36
Q

What do you do after treatment

A

Repeat scope in 3 months

Test for H.pylori

37
Q

What suggests perforation / haemorrhage of ulcer

A

Severe persistent back pain

Sudden onset

38
Q

What causes haemorrhage

A

Ulcer eroding artery

39
Q

Gastric

A

Pain worse with eating

40
Q

Duodenal

A

Pain relieved by eating as neutralised

41
Q

What do you do if prescribing NSAID in elderly

A

Prescribe with omeprazole

42
Q

What is CI in perforation

A

Endoscopy as damage further

43
Q

What artery is eroded

A

Gastroduodenal

44
Q

What is pernicious anaemia

A

Autoimmune attack on gastric parietal and intrinsic factor

45
Q

What are the symptoms

A 
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
Q

What is associated

A 
Blood group A
Thyroid
DM
Coeliac 
Addison
47
Q

How do you Dx

A

Megaloblastic microcytic

Ab intrinsic factor = diagnostic

48
Q

Rx

A

IM b12

Folic acid

49
Q

Risk

A

Predispose to gastric cancer

50
Q

How do you treat MALT lymhpoma

A

Eradicate H.pylori

51
Q

How do you investigate perforation

A

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
Q

What is good marker if patient sick

A

Lactate

53
Q

If smoker / alcohol + sudden onset abdo pain

A

Think perforated ulcer

Pancreatitis

54
Q

What is a good screener upper GI bleed

A

Urea

GI (29 decks)

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