General Flashcards
Hilicobacter Pylori
Gram negative, spiral bacillus, urease positive, transmissible via oral-oral or faecal-oral routes
Causes of dyspepsia
Idiopathic, ulcers, GORD, hiatus hernia, H Pylori, medication, cancer
Possible consequences of H Pylori infection?
No symptoms, Mild gastritis, PUD, dyspepsia, adenocarcinoma, MALToma
3 most important causes of gastritis?
H Pylori, drugs ie NSAIDS, autoimmunity
2 commonest causes if peptic ulcers?
H Pylori and NSAIDS
How do you test for H Pylori?
Serology - IgG Ab, Urea breath test for active infection
What is the standard triple combination therapy of H Pylori eradication?
PPI and 2 antibiotics - amoxicillin, Clarithromycin or metronidazole
What is used in macrolide resistance?
Levofloxacin
Apart from triple, what other therapies can be used?
Quadriple and sequential (5 day PPI and amoxicillin followed by 5 day pop and Clarithromycin and metronidazole)
What differentiates physiological from pathological reflux
Mucosal injury, nocturnal episodes
Complications of GORD?
Stricture, ulcers, Barrets oesophagus, cancer, laryngeal and respiratory complications
What is the difference between pan gastritis and antral gastritis caused by H Pylori?
Pan gastritis causes decreased acid production, antral gastritis - increased acid production
What is Zollinger-Ellison syndrome?
A tumour producing excess gastrin causing excess acid release
Causes of acute ulcers?
NSAIDS, ischaemia, sock, burns, organ failure, ingestion of caustics
Causes of chronic ulcers?
NSAIDS and H Pylori, lifestyle factors?
Investigations in suspected cancer
Endoscopic ultrasound, CT, laparoscopy with biopsy of nodules of the peritoneal surface, laparoscopy ultrasound for liver metastasis
Treatment of gastric adenocarcinoma
Endoscopic resection, gastrectomy, radiotherapy, chemotherapy
What do parietal cells produce?
IF and acid
What do chief cells do?
Secrete pepsinongens which initiate protein digestion
What do endocrine cells do?(3)
Enterochromaffin link cells - histamine, G cells - gastrin, D cells - somatostatin
Which pump releases acid?
H-K pump
Role of prostaglandins in the stomach?
Central role in epithelial defence/repair, regulate release of HCO3 and mucus, maintain mucosal blood flow, cell restitution
How are prostaglandins produced?
Phospholipids to arachadonic acid to prostaglandins via actions of phosholipase a2 and cyclooxygenase
Molecular consequences of H Pylori infection?
Antral inflammation, increased gastrin, decreased somatostatin, increased acid, urease activity converting urea to ammonia and carbon dioxide
