Gastritis and PUD

Question 1

what are the causes of Gastritis?

Answer 1

H. Pylori 
NSAIDS 
Autoimmune 
Stress induced in critically ill 
Phlegmonous gastritis induced by S.Aureus, streptococci, E.coli

Question 2

How does H.Pylori cause Gastritis?

Answer 2

severe inflammatory response to infection with gastric mucin degradation and increased mucosal permeability, followed by gastric epithelial cytotoxicity

Question 3

How do NSAIDS contribute to gastritis?

Answer 3

they inhibit COX and reduce prostaglandin production. Prostaglandins are gastroprotective as they maintain gastric mucosal blood flow and increase protective mucus as well as bicarbonate production. Therefore reduction in prostaglandins leads to gastric mucosal damage

Question 4

what are the S&S of gastritis?

Answer 4

• dyspepsia
• epigastric pain
• Nausea and vomiting
• loss of appetite
• altered reflexes, sensory deficits and glossitis if B12 deficiency

Question 5

How would you investigate gastritis?

Answer 5

H. Pylori urea breath test

H. Pylori faecal antigen

FBC
- May show decreased Hb and haematocrit with increased MCV (megaloblastic anaemia) in autoimune gastritis

Endoscopy with biopsy
- gastric erosions and atrophy

Serum B12
- reduced in autoimmune gastritis due to pernicious anaemia

Question 6

what are the treatment options for the various types of gastritis?

Answer 6

H. Pylori associated
- Triple therapy i.e omeprazole, clarithromycin and amoxicillin

Autoimmune
- cyanocobalamin for B12 depletion

Question 7

what is the definition of peptic ulcer disease?

Answer 7

a break in the mucosal lining of the stomach or duodenum more than 5mm in diameter, with depth to the submucosa. Ulcers smaller than this or without obvious depth is called erosions

Question 8

what is the aetiology of PUD?

Answer 8

H. Pylori 
Aspirin and NSAIDs
KCL and bisphosphonates 
Gastric ischaemia 
Zollinger-Ellison Syndrome 
Infections - CMV in HIV, HSV

Question 9

What are the S&S of PUD?

Answer 9

• dyspepsia
• epigastric pain (may radiate to back in duodenal ulcers as the ulcer penetrates posteriorly into the pancreas)
• Pointing sign (pt can show sign of pain with one finger)
• epigastric tenderness
• Nausea relieved by eating
• Vomiting after eating
• Weight loss and anorexia

Question 10

what are the ALARM symptoms in PUD?

Answer 10

Anaemia 
Loss of weight 
Anorexia 
Recent onset 
Melaena/haematemesis 
Swallowing difficulty

Question 11

What are the investigations in PUD?

Answer 11

Endoscopy

H. Pylori C-13 urea breath test (leave 2 week washout period after PPI use and 4 weeks after ABx to avoid false negatives)

H. Pylori faecal antigen

FBC - microcytic anaemia

Fasting serum gastrin - hypergastinaemia in Zollinger Ellison Syndrome

Question 12

What is the treatment options for PUD?

Answer 12

triple therapy

• omeprazole, amox and clarithromycin
• if penicillin allergy then PPI + clarithromycin + Metronidazole

H2 receptor antagonist

Avoid NSAIDs and aspirin

Question 13

what are the complications of PUD?

Answer 13

Perforation

Upper GI bleed

Gastric outlet obstruction
- pyloric stenosis due to healing and scarring of ulcers

Penetration
- ulcer penetrates entire thickness of the stomach or duodenal wall into adjacent organ e.g pancreas, without free perforation into peritoneal cavity