gastric: ulcers, bleeds + cancer Flashcards
what warrant urgent dyspepsia cancer referrals (5/6)
dysphagia // upper abdo mass // >55 with weight loss + dyspepsia OR reflex OR abdo pain
what warrants non-urgent dyspepsia cancer referrals
haematemesis // treatment resistant dyspepsia // low hb // raised platelets
what is treatment for dyspepsia without need for OGD
- med review 2. lifestyle 3. 1 month PPI OR H pylori treatment
what gram is H pylori
negative
what conditions are associated with H pylori (4)
peptic ulcers // gastric cancer // MALT // atrophic gastritis
what is the most sensitive and specific test for H pylori (3)
urea breath test // rapid urea test (CLO) - less sensitive // stool antigen
what test is used to determine eradication of H pylori
urea breath test
mx H pylori
PPI + amox + clarithromycin OR metro // triple therapy no amox if pen allergy
what drugs can cause peptic ulcers
NSAIDs, SSRIs, corticosteroids, biphosphonates
how do gastric and duedenal ulcers present differently and which is most common
duodenal - more common and relieved by eating // gastric worse on eating
how are peptic ulcers treated if H. pylori negative
PPI until healed
what artery is usually involved in peptic ulcer acute bleeds
gastroduodenal
presentation of peptic ulcer acute bleeds
haematemesis, maleana, hypotension, tachycardia
mx peptic ulcer acute bleeds
ABCDE —>first line endoscopy
what symptom is common in peptic ulcer perforation
syncope
invx for perforated peptic ulcer
erect CXR
what are risk cancers/ demographic for gastric cancer (7)
male, elderly, H pylori, atrophic gastritis, diet, smoking
what lymph nodes does gastric cancer spread too
left supraclavicular (virchow’s) and periumbilical
what type of gastric cancer is H pylori accos with
adenocarcinoma (most common) and MALT lymphoma
what is seen on biopsy in gastric cancer
OGD + biopsy –> signet cells
how js gastric cancer staged
CT
what surgical options are available for gastric cancer
endoscopic mucosal resection –> partial gastrectomy –> total gastrectomy
what adjuvant can be given in gastric cancer
chemo
what are complications of gastrectomy
dumping syndrome / weight loss / anaemia / osteoporosis / vit B12
what is dumping syndrome
rebound hypoglycaemia
what blood restult can a MALT lymphoma be associated with
paraproteinaemia
what autoimmune condition is MALT assoc with
Thyroid + sjorgens
what are the most common causes of an upper GI bleed
varisces, peptic ulcer, (mallor weiss, boeerhaave)
what blood test may indicate upper GI bleed
raised urea (blood in stomach broken down to urea)
what is the glasgow blatchford score used for
determine whether GI bleeds need urgent care
what are the components of the glasgow blatchford score (4)
urea // Hb // BP // pulse or malena or syncope or hepatic or cardiac disease
what score on glasgow blatchford score would indicate discharge
0
what is 1st mx step in upper GI bleed
ABC, wide bore IV // platelets if bleeding // FFP if needed //
when would prothrombin complex be indicated in upper GI bleed
if on warfarin and actively bleeding
in what time frame should all upper GI patients have an endoscopy
24hrs
when should PPI’s be given in a GI bleed
after OGD if non-variceal bleed ie peptic ulcer