Gastritis/duodenitis

Question 1

What are the most common causes of gastritis/duodenitis?

Answer 1

H.pylori infection,
Alcohol,
NSAIDs,
Others: Stress, autoimmune gastritis

Question 2

What are the clinical features of gastritis/duodenitis?

Answer 2

Dyspepsia/epigastric discomfort,
Nausea,
Vomiting,
Loss of appetite,
Uncommon = signs of B12 def (autoimmune gastritis), signs of phlegmonous gastritis (fever, acute abdo pain)

Question 3

What are the differential diagnosis for gastritis/duodenitis?

Answer 3

Peptic ulcer disease, GORD, non-ulcer dyspepsia, gastric lymphoma/carcinoma

Question 4

What are the investigations for gastritis/duodenitis?

Answer 4

1st - H. pylori urea breath test (must be off abx for 4 weeks and PPIs for 2 weeks) or H. pylori fecal antigen test. Also do FBC

Question 5

what is stress induced GI bleeding?

Answer 5

Can occur in critically ill paitnets. Main risk factors are mechanical ventilation for >48h and coagulopathy. Treat with

Question 6

What is autoimmune gastritis?

Answer 6

Antibodies targeted to gastric parietal cells.

Question 7

What is phlegmonous gastritis?

Answer 7

Acute gastritis caused by different bacteria eg, staphylococcus, streptococci or gram negatives.
Do culture of gastric contents (via NG drainage) and blood cultures

Question 8

What is the treatment of gastritis/duodenitis?

Answer 8

Treat underlying cause. This may include:
H pylori eradication therapy,
Discontinue NSAIDs,
Reduce alcohol intake,
Replace vitamin B12 in autoimmune gastritis
Stress gastritis - H2 antagonists or PPI

Question 9

What is the H pylori eradication therapy?

Answer 9

PPI + amox/metronidazole + clarithromycin for 7 days

Question 10

What is the pathophysiology of pernicious anaemia?

Answer 10

Antibodies to intrinsic factor +/- gastric parietal cells. Intrinsic factor is what binds to B12. Parietal cells make intrinsic factor and promote acid production

Question 11

What are the features of pernicious anaemia?

Answer 11

Anaemia symptoms.
Peripheral neuropathy, subacute degeneration of the spinal cord, neurophsyciatric.
Lemon tinge and glossitis

Question 12

What are the investigations for pernicious anaemia?

Answer 12

FBC - macrocytic anaemia, hypersegmented neutrophils.
Haematinics - low B12.
Antibodies - anti intrinsic factor antibodies

Question 13

What are the treatments and complication of pernicious anaemia?

Answer 13

Treat - IM vitamin B12 - 3 injections per week for 2 weeks followed by top up every 3 months.

Complication - Gastric cancer