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Gastro > Gastric Problems > Flashcards

Gastric Problems Flashcards

1
Q

What is gastritis

A

Inflammation of the stomach lining

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2
Q

What causes gastritis [5]

A

Autoimmune
H.pylori

Chemical
Drugs - NSAIDs / cocaine, Alcohol
Bile reflux = inflammation
Stress - surgery / burns
Crohns

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3
Q

How does H.pylori cause gastritis [2]

A

H.pylori

  • 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 [8]

A

Dyspepsia
Burning stomach pain (worse after eating and better nil by mouth)
N+V
Early satiety
Bleeding or ulcer formation if lining worn away, IDA if bleeding
Pernicious anaemia due to lack of intrinsic factor
NO WEIGHT LOSS
SYSTEMICALLY WELL

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5
Q

When does gastritis tend to lead to bleeding [2]

A

Impaired coagulation

Medication - anti platelet / coagulant

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6
Q

How do you Dx gastritis [5]

A 
Stool test looking for infection / blood
FBC - low Hb
Urea breath test for H.pylori
Endoscopy + biopsy - rapid urea test CLO 
Barium swallow
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7
Q

How do you treat gastritis [4]

A

Treat underlying cause
Antacids / milk will improve
PPI
H2 blocker - not always needed

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8
Q

What are the complications of gastritis [6]

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

How does urea breath test work [2]

A

Urea split by urease into HCO3+NH4

CO2 is detected

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10
Q

What is the autoimmune attack in gastritis that causes B12 deficiency [4]

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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11
Q

Which part of the GI system does peptic ulceration affect [3]
Indicate most common

A

Lower oesophagus
Body and Antrum
Duodenum - most common

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12
Q

Pathogenesis: peptic ulcers

A

Imbalance between acid secretion and mucosal barrier

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13
Q

What is associated with peptic ulcers [3]

A

H.pylori - stimulate acid production
Eradication will heal 90%
Increased acid = duodenal
Inflammatory response = gastric

NSAID - suppress prostaglandin synthesis leading to inflammation
Prescribe omeprazole if not CI with NSAID in elderly
Other drugs

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

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14
Q

What are the symptoms of peptic ulcers [6]

A 
Epigastric / back pain
Nocturnal hunger pain 
N+V, Haematemesis 
Weight loss, Anorexia
Haematochezia - fresh, malaena
No vomiting (differentiate from pancreatitis)
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15
Q

What are the RF for peptic ulceration [6]

What drugs are included under risk factors [4]

A 
H.PYLORI
Alcohol, Smoking 
Zollinger Ellison Syndrome 
Delayed gastric emptying 
Stress - surgery / burns
Spicy food
Crohn's but rare

Drugs:
NSAIDs, Steroid
SSRI
Biphosphonate

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16
Q

How do you diagnose peptic ulcer [4]

A

Stool test or urea breath test for H.pylori
Endoscopy
Barium swallow
Measure gastric conc when off PPI for Zollinger Ellison Syndrome

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17
Q

How do you investigate perforation [5]

A 
Blood test 
CXR - small air (large if colonic)
CT or laparoscopy 
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
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18
Q

How do you treat peptic ulceration [5]

A 
PPI if H. Pylori negative
H.pylori eradication
Stop NSAID
Alternative pain relief 
Lifestyle modifications
Surgery if perforation
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19
Q

How do you treat bleeding in peptic ulcers [6]

A 
ABCDE
Endoscopy, PPI after 
Inject adrenaline
Clip
Thermal contact
Haemospray
Angiography with embolisation
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20
Q

What are the complications of peptic ulcer [6]

A 
Haemorrhage
Perforation > peritonitis 
Gastric outlet obstruction
Fibrosis, Pyloric stenosis 
Polyps 
Tumour
21
Q

What is gastric outlet obstruction

A

Any disease that produces a mechanical impediment to gastric emptying

22
Q

What causes gastric outlet obstruction [6]

A 
Stricture
Ulcer
Cancer
Polyps
Pyloric stenosis (congenital)
Hiatus hernia
23
Q

Presentation pyloric stenosis [5]

A 
Vomiting - no bile (clear fluid from saliva and gastric juice) > dehydration
Early satiety, Weight loss
Distention
Gastric splash 
Renal impairment
24
Q

How do you diagnose gastric outlet obstruction [2]

A

Upper GI endoscopy

Bloods - low Cl, Na, K, renal impairment > Metabolic alkalosis

25
Q

How do you treat gastric outlet obstruction [3]

A

Endoscopic balloon dilatation
Surgery
Treat electrolyte / fluid replace

26
Q

What are the complications of gastric outlet obstruction [4]

A

Dehydration
Renal impairment
Metabolic alkalosis
Risk of aspiration pneumonia

27
Q

What do you do if symptoms of gastritis persist [3]

A

Re-endoscope
Retest H.pylori
Consider Ddx

28
Q

Perforation of gastric ulcer

Immediate management [3]

A
  1. Immediate:
    - NBM, IV fluids, catheter, NGT +/- CVP line
    - MORPHINE and CYCLIZINE
    - IV abx (CEFRTIAXONE and METRONIDAZOLE)
29
Q

What is most common ulcer

A

Duodenal

The pain of duodenal ulcer is slightly different to that of gastric ulcers and often occurs several hours after eating.

30
Q

What does it predispose you to

A

Gastric cancer

31
Q

What are the RF for gastritis [8]

A 
Smoking
Alcohol
NSAID
H.pylori
Reflux
Hiatus hernia
CMV
Zollineger Ellison Syndrome
32
Q

What can H.pylori also cause [4]

A

Peptic ulceration = most common
Gastric cancer
Gastritis
MALT lymphoma

33
Q

What must you do before endoscopy

A

Stop PPI / H2 antagonist as can hide

34
Q

What do you do after treatment [2]

A

Repeat scope in 3 months

Test for H.pylori

35
Q

What suggests perforation / haemorrhage of ulcer [2]

A

Severe persistent back pain

Sudden onset

36
Q

What causes haemorrhage

A

Ulcer eroding artery

37
Q

Subsequent mx in peptic ulcer perforation [3]

A

Conservative

Laparotomy: always take biopsy to excl. ca
 Duodenal: abdo wash out and omental patch repair
 Gastric: excise ulcer and repair defect

Test and treat for H. pylori

38
Q

When would you be conservative in management in a perforated ulcer?

A

If not peritonitis, careful monitoring with IV fluids and abx (omentum may seal perforation spontaneously avoiding surgery)

39
Q

What artery is eroded

A

Gastroduodenal

40
Q

What is pernicious anaemia

A

Autoimmune attack on gastric parietal and intrinsic factor

41
Q

What are the symptoms pernicious[8]

A 
Lethargy
SOB, Pallor
Paresthesia / Neuropathy / reduced sensation due to degeneration of spinal cord 
Mild jaundice
Retinal haemorrhage
Mild splenomegaly
Sore tongue
Diarrhoea
42
Q

What is associated [4]

A

Blood group A
Thyroid
DM
Addison

43
Q

How do you Dx [2]

A

Megaloblastic microcytic
anti-intrinsic factor abs
anti-patietal cell abs

44
Q

Rx [2]

A

IM B12

Folic acid

45
Q

Risk

A

Predisposes to gastric

46
Q

How do you treat MALT lymhpoma

A

Eradicate H.pylori

47
Q

How does pain and factors help us to differentiate between duodenal and gastric ulcer

A

Pain relieved by eating / milk = duodenal ulcer as neutralised
Pain worse on eating / 30 mins after / relieved by antacids = gastric

48
Q

Zollinger Ellison syndrome investigations

A
  • Fasting plasma gastrin level: elevated if >150 pg/mL; a level >1000 pg/mL is virtually diagnostic.
  • Gastric pH measurement:
    a pH > 3 makes ZES very unlikely.
  • Somatostatin receptor scintography and CT may localise the lesion.
  • EUS to identify and sample possible gastrinomas around the stomach, duodenum and within the
    pancreas.
49
Q

Factors to consider when ordering fasting plasma gastrin level

A
  • Anti-secretory therapy can cause a rise in plasma gastrin and should be stopped for  week prior to
    testing.
  • Low acid output states such as atrophic gastritis and pernicious anaemia can also result in
    hypergastrinaemia.

Gastro (17 decks)

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