GI 5.1 Gastric Disease

Question 1

Briefly describe GORD and list the symptoms associated with it

Answer 1

Gastro-oesophageal reflux disease
Reflux of stomach contents into the oesophagus
Heartburn, cough and wheeze, sore throat, dysphagia or painful swallowing

Question 2

List some common gastric disorders

Answer 2

GORD
Gastritis (acute / chronic -bacterial or autoimmune)
Peptic ulcer disease
Zollinger-Ellison disease
Stress ulcers
Cancer of the stomach

Question 3

Describe the potential causes of GORD

Answer 3

Lower oesophageal sphincter problems
Delayed gastric emptying (causes inc. intra gastric pressure)
Hiatus hernia
Obesity

Question 4

Besides the unpleasant symptoms, what problems might GORD lead to?

Answer 4

Oesophagitis
Strictures
Barrett’s oesophagus

Question 5

*MoD What is Barrett’s oesophagus and why is it of clinical note?

Answer 5

Metaplasia of squamous epithelium to columnar

Hugely increases risk of adenocarcioma

Question 6

How is GORD treated?

Answer 6

Lifestyle modifications (smaller meals, posture etc)
Pharmacologically with antacids, H2 antagonists and PPIs
Rarely surgery

Question 7

Briefly describe acute gastritis and list some causes.

Answer 7

Acute mucosal inflammatory process

Heavy NSAID use, excess alcohol, chemo, bile reflux (fairly uncommon)

Question 8

Describe the symptoms of acute gastritis

Answer 8

Asymptomatic
or pain, nausea, vomiting
!and occasionally bleeding (can be fatal)

Question 9

Describe the causes of chronic gastritis

Answer 9

Most commonly bacterial - H pylori
Auto-immune - antibodies to gastric parietal cells produced, can lead to pernicious anaemia (as parietal cells also produce intrinsic factor which is needed for absorption of vit B12)
Also causes of acute but these cause minimal inflammation

Question 10

Describe the symptoms of chronic gastritis

Answer 10

H-pylori - asymptomatic or similar to acute
symptoms may develop due to complications
Auto-immune - anaemia symptoms, glossitis (tongue), anorexia, neuro symptoms (eg visual disturbances)

Question 11

Describe peptic ulcer disease and where it commonly affects

Answer 11

Defects in gastric/duodenal mucosa
Must extend through mucularis mucosa
Most common in 1st part of duodenum, also commonly affects lesser curve of stomach

Question 12

Describe peptic ulcer disease and where it commonly affects

Answer 12

Defects in gastric/duodenal mucosa
Must extend through mucularis mucosa
Most common in 1st part of duodenum, also commonly affects lesser curve of stomach

Question 13

What are the normal defence mechanisms of the stomach and duodenum from stomach acid?

Answer 13

Mucus, 
Bicarbonate, 
Adequate blood flow (can remove acid that diffuses through damaged mucosa), 
Prostaglandins as stimulate ^ 
Epithelial renewal

Question 14

Describe the causes of peptic ulcer disease

Answer 14

Mucosal injury from:
Stomach acid 
H-pylori 
NSAIDs 
NB smoking only in relapses also massive physiological stress not psychological stress

Question 15

What are the symptoms of peptic ulcer disease and which of these are serious

Answer 15

Epigastric pain (sometimes back pain) - burning/gnawing, follows meal times and often at night

• Bleeding or anaemia - indicates penetration of vessel !gastro-duodenal artery is in vulnerable position
• Early satiety
• Weight loss

Question 16

Describe the investigation of peptic ulcer disease

Answer 16

Upper endoscopy and biopsy - benign/malignant ulceration, H-pylori
Urease breath test - H-pylori
Erect chest Xray - perforation
Bloods - anaemia

Question 17

What drugs are used in the treatment of H-pylori

Answer 17

Triple therapy: PPI + clarithromycin +amoxicillin

Question 18

What drugs are used in the treatment of H-pylori

Answer 18

Triple therapy: PPI + clarithromycin +amoxicillin

Question 19

How can acid secretion be reduced pharmacologically?

Answer 19

PPIs (eg cimetidine, ranitidine) - blocks parietal cell H+ pump 
H2 blockers (eg omeprazole) - blocks histamine receptor on parietal cells

Question 20

Describe the main features of H-Pylori bacteria

Answer 20

Oral-oral/faeco-oral spread
Helical gram neg
Produces urease (inc local pH)
Has flagellum - good motility, adheres to gastric epithelia, resides w/n mucus layer

Question 21

What effect does H pylori have if it colonises the antrum of the stomach?

Answer 21

Increased gastrin secretion (G cells)

Increased parietal cell acid secretion -> duodenal epithelial metaplasia

Question 22

What effect does H pylori have if it colonises the antrum?

Answer 22

Increased gastrin secretion (G cells)

Increased parietal cell acid secretion -> duodenal epithelial metaplasia

Question 23

What effect does H pylori have if it colonises the antrum and the body of the stomach?

Answer 23

Asymptomatic

Question 24

What is Zollinger-Ellison syndrome?

Answer 24

Non-beta-islet-cell gastrin-secreting tumour of the pancreas. May be part of MEN1 (multiple endocrine neoplasia)

Question 25

Describe the effects of Zollinger-Ellison syndrome

Answer 25

Proliferation of parietal cells -> lots of acid production -> severe ulceration of stomach and small bowel -> abdo pain and diarrhoea (poor absorption)

Question 26

Describe the effects of Zollinger-Ellison syndrome

Answer 26

Proliferation of parietal cells -> lots of acid production -> severe ulceration of stomach and small bowel -> abdo pain and diarrhoea (poor absorption)

Question 27

Why do patients with stomach cancer often present late?

Answer 27

Tumour has to be quite large before it causes symptoms

Question 28

Describe the symptoms of stomach cancer

Answer 28

Dysphagia, anorexia, malaena (black tarry faeces), wieght loss, nuasea/vomiting, Trosier’s sign = enlarged Virchow’s node (lymph node in L supraclavicular fossa)

Question 29

What are the risk factors for stomach cancer?

Answer 29

Male, H-pylori, dietary factors (high salt, and high fat to a degree), smoking

Question 30

What histological classification are most stomach cancers?

Answer 30

Adenocarcinomas

Question 31

Describe the investigations for stomach cancer

Answer 31

Bloods - cancer markers, Upper GI endoscopy, CT