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Y3 Lecture week IV > Gastro-duodenal disease > Flashcards

Gastro-duodenal disease Flashcards

With the pathologist series 4a: -Helicobacter pylori -GORD - Barrett’s oesophagus - coeliac disease

1
Q

What diseases may be the associated with H. Pylori?

A

Associations

  • peptic ulcer disease (95% of duodenal ulcers, 75% of gastric ulcers)
  • gastric cancer
  • B cell lymphoma of MALT tissue (eradication of H pylori results causes regression in 80% of patients)
  • atrophic gastritis
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2
Q

What type of an organism H Pylori is?

A

Helicobacter pylori is a Gram negative bacteria

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3
Q

Management of H. Pylori

A

Management - eradication may be achieved with a 7 day course of:

  • a proton pump inhibitor + amoxicillin + clarithromycin, or
  • a proton pump inhibitor + metronidazole + clarithromycin
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4
Q

Signs and symptoms of H. Pylori infection

A
  • 85% of infected people asymptomatic
  • Acute -> acute gastritis: abdominal pain, nausea
  • Chronic: dyspepsia like symptoms -> bloating, belching/burping, abdominal pain, vomiting, dark stool
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5
Q

Investigations in H. Pylori

A
  • blood antibody test
  • stool antigen test
  • carbon urea breath test
  • endoscopic biopsy
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6
Q

What’s that?

A

Normal gastric mucosa

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7
Q

What’s that?

A

Inflammatory gastritis / H. Pylori -> foll of ‘blue dots’ = inflammatory cells

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8
Q

How does Helicobacter Pylori survive in the stomach (considering it’s an acidic environment)?

A
  • H. Pyloris produce large amounts of enzyme urease -> it converts urea into CO2 and ammonia
  • there is a protective layer around the bacterium (neutral pH)
  • bacteria enters gastric mucosa away from acidic content of the lumen
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9
Q

Why complications (malignancy) of H Pylori occur?

A

This is due to constant irritation by a bacteria -> inflammation -> ulcer may form

When we eradicate the bacteria and ulcer heals -> gastric mucosa may re-generate into an intestinal type of epithelium (metaplasia)

If irritation persists -> another change in mucosa may occur -> dysplasia

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10
Q

Is low-grade MALT lymphoma treatable? How?

A

Antibiotics to eradicate H. Pylori

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11
Q

What’s that?

A

Adenocarcinoma (intramucosal)

  • Normal glands -> on the right
  • bizarre, crowded glands, strange nuclei -> on the left (cancer)
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12
Q

What’s that?

A

MALT lymphoma (B-cell lymphoma)

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13
Q

What are different types of gastritis?

A
  • H Pylori gastritis
  • reactive (chemical or reflux) gastritis
  • lymphocytic gastritis (may or not be associated with H pylori)
  • autoimmune gastritis
  • iron pill gastritis - iron tablets may irritate gastric mucosa
  • granulomatous gastritis (Crohn’s, idiopathic, foreign body, sarcoidosis, TB)
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14
Q

What changes occur in Barrett’soesophagus?

A

metaplasia of the lower oesophageal mucosa:

squamous epithelium (oesophagus) -> replaced by columnar epithelium (gastric)

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15
Q

What’s the management of Barrett’s oesophagus?

A

Management

  • endoscopic surveillance with biopsies (as the risk of oesophageal cancer) -> endoscopy every 3-5 years
  • high-dose proton pump inhibitor
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16
Q

Why we may get cancer of oesophagus if we have GORD/ Barrett’s? (pathophysiology of Ca development)

A

Gastric acid reflux into the oesophagus or even bile reflux possible -> acid in the oesophagus (squamous epithelium is not used to acid) -> ulcers -> repair as a different type of epithelium (e.g. gastric or intestinal, as they can resist the aid damage)

17
Q

Pathophysiology of GORD

A
  • Retrograde flow of gastric or sometimes duodenal content into the oesophagus
  • This happens due to loss of lower oesophageal sphincter (LOS) pressure gradient
18
Q

Management of dyspepsia in primary care

A

1st line:

    • PPI*
  • H.Pylori ‘test and treat’

2nd line:

H2 receptor antagonist (if PPI is not effective)

19
Q

Simple pathophysiology of Coeliac disease

A

Coeliac disease is an autoimmune condition caused by sensitivity to the protein gluten -> repeated exposure to gluten -> villous atrophy -> malabsorption -> symptoms

20
Q

What other diseases is Coeliac disease associated with?

A
  • dermatitis herpetiformis
  • type 1 diabetes mellitus
  • autoimmune hepatitis
21
Q

What symptoms should prompt investigation for Coeliac Disease?

A
  • Chronic or intermittent diarrhoea
  • Failure to thrive or faltering growth (in children)
  • Persistent or unexplained gastrointestinal symptoms including nausea and vomiting
  • Prolonged fatigue (‘tired all the time’)
  • Recurrent abdominal pain, cramping or distension
  • Sudden or unexpected weight loss
  • Unexplained iron-deficiency anaemia, or other unspecified anaemia
22
Q

Presence of which conditions should prompt an investigation for Coeliac Disease?

A
  • Autoimmune thyroid disease
  • Dermatitis herpetiformis
  • Irritable bowel syndrome
  • Type 1 diabetes
  • First-degree relatives (parents, siblings or children) with coeliac disease
23
Q

What genes are associated with Coeliac disease?

A

HLA-DQ2 (95% of patients) and HLA-DQ8 (80%).

24
Q

How Coeliac Disease is investigated?

A

combination of immunology and jejunal biopsy

Immunology

  • tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
  • endomyseal antibody (IgA)
  • anti-casein antibodies -> found in some patients

Biopsy

25
Q

Changes found on biopsy in Coeliac Disease

A

Duodenal biopsy (occasionally also jejunal)

  • villous atrophy
  • crypt hyperplasia
  • increase in intraepithelial lymphocytes
  • lamina propria infiltration with lymphocytes
26
Q

Management of Coeliac Disease

A
  • a gluten-free diet

Tissue transglutaminase antibodies may be checked to check compliance with a gluten free diet

  • functional hyposplenism (often in patient’s with Coeliac Disease) -> pneumococcal vaccine and possibly influenza vaccine
27
Q

Diet in Coeliac disease

  • examples of foods that contain gluten
  • what does not contain gluten
  • can a patient drink whisky?
A

Gluten containing cereals include:

  • wheat: bread, pasta, pastry
  • barley*: beer
  • rye
  • oats (some patients may tolerate them)

Some notable foods which are gluten-free include:

  • rice
  • potatoes
  • corn (maize)

*whisky is made using malted barley. Proteins such as gluten are however removed during the distillation process making it safe to drink for patients with coeliac disease

28
Q

Other diseases where histological changes that are similar to Coeliac disease

A
  • other food intolerances
  • autoimmune enteropathy
  • tropical sprue
  • post-infectious gastroenteritis
  • H. Pylori (affects gastric mucosa but may cause changes in duodenum)
  • bacterial overgrowth
  • Kwashiorkor
29
Q
A

Y3 Lecture week IV (18 decks)

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