GI 5.1 Gastric Disease Flashcards
Briefly describe GORD and list the symptoms associated with it
Gastro-oesophageal reflux disease
Reflux of stomach contents into the oesophagus
Heartburn, cough and wheeze, sore throat, dysphagia or painful swallowing
List some common gastric disorders
GORD Gastritis (acute / chronic -bacterial or autoimmune) Peptic ulcer disease Zollinger-Ellison disease Stress ulcers Cancer of the stomach
Describe the potential causes of GORD
Lower oesophageal sphincter problems
Delayed gastric emptying (causes inc. intra gastric pressure)
Hiatus hernia
Obesity
Besides the unpleasant symptoms, what problems might GORD lead to?
Oesophagitis
Strictures
Barrett’s oesophagus
*MoD What is Barrett’s oesophagus and why is it of clinical note?
Metaplasia of squamous epithelium to columnar
Hugely increases risk of adenocarcioma
How is GORD treated?
Lifestyle modifications (smaller meals, posture etc)
Pharmacologically with antacids, H2 antagonists and PPIs
Rarely surgery
Briefly describe acute gastritis and list some causes.
Acute mucosal inflammatory process
Heavy NSAID use, excess alcohol, chemo, bile reflux (fairly uncommon)
Describe the symptoms of acute gastritis
Asymptomatic
or pain, nausea, vomiting
!and occasionally bleeding (can be fatal)
Describe the causes of chronic gastritis
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
Describe the symptoms of chronic gastritis
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)
Describe peptic ulcer disease and where it commonly affects
Defects in gastric/duodenal mucosa
Must extend through mucularis mucosa
Most common in 1st part of duodenum, also commonly affects lesser curve of stomach
Describe peptic ulcer disease and where it commonly affects
Defects in gastric/duodenal mucosa
Must extend through mucularis mucosa
Most common in 1st part of duodenum, also commonly affects lesser curve of stomach
What are the normal defence mechanisms of the stomach and duodenum from stomach acid?
Mucus, Bicarbonate, Adequate blood flow (can remove acid that diffuses through damaged mucosa), Prostaglandins as stimulate ^ Epithelial renewal
Describe the causes of peptic ulcer disease
Mucosal injury from: Stomach acid H-pylori NSAIDs NB smoking only in relapses also massive physiological stress not psychological stress
What are the symptoms of peptic ulcer disease and which of these are serious
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
Describe the investigation of peptic ulcer disease
Upper endoscopy and biopsy - benign/malignant ulceration, H-pylori
Urease breath test - H-pylori
Erect chest Xray - perforation
Bloods - anaemia
What drugs are used in the treatment of H-pylori
Triple therapy: PPI + clarithromycin +amoxicillin
What drugs are used in the treatment of H-pylori
Triple therapy: PPI + clarithromycin +amoxicillin
How can acid secretion be reduced pharmacologically?
PPIs (eg cimetidine, ranitidine) - blocks parietal cell H+ pump H2 blockers (eg omeprazole) - blocks histamine receptor on parietal cells
Describe the main features of H-Pylori bacteria
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
What effect does H pylori have if it colonises the antrum of the stomach?
Increased gastrin secretion (G cells)
Increased parietal cell acid secretion -> duodenal epithelial metaplasia
What effect does H pylori have if it colonises the antrum?
Increased gastrin secretion (G cells)
Increased parietal cell acid secretion -> duodenal epithelial metaplasia
What effect does H pylori have if it colonises the antrum and the body of the stomach?
Asymptomatic
What is Zollinger-Ellison syndrome?
Non-beta-islet-cell gastrin-secreting tumour of the pancreas. May be part of MEN1 (multiple endocrine neoplasia)
