GI: Common gastric disease Flashcards
What is dyspepsia and how common is it?
Dyspepsia is upper GI symptoms (stomach pain in epigastric region) lasting 3+ months
Up to 40% of adults suffer with dyspepsia
What is GORD? How does it present?
Gastic oesophageal reflux disease
Symptoms include heartburn, cough, sore throat, dysphagia
What are the causes of GORD?
Obesity - higher intra abdo pressure
Hiatus hernia - upper part of stomach herniates into thorax via lower oesophageal sphincter
Delayed gastric emptying (eg diabetes) raises the intra gastric pressure
Problems with the lower oesophageal sphincter
What is a complication of GORD?
Can cause Barretts oesophagus which is a metaplastic change from squamous to columnar epithelium which increases the risk of developing adenocarcinoma by 30-40x
How is GORD treated?
Lifestyle modifications: quit smoking, lose weight, eat smaller more frequent meals, cut down alcohol
Pharmacological: OTC antacids, H2 antagonists, PPIs
Surgery: (rare) wrap fundus around lower oesophagus to support the sphincter
What are the causes of acute gastritis?
Heavy use of NSAIDs (inhibit prostaglandins), heavy alcohol, chemotherapy, bile reflux through pyloric sphincter
What are the symptoms of acute gastritis?
Asymptomatic, or pain nausea vomiting and occasionally bleeding which can be fatal
What are the causes of chronic gastritis?
Most common cause is helicobacter pylori infection
Can be autoimmune - antibodies against parietal cells (can also lead to pernicious anaemia because parietal cells secrete intrinsic factor needed for absorption of vit B12)
What are the symptoms of chronic gastritis?
H Pylori infection - asymptomatic or pain vomiting nasea, or may develop symptoms from complications eg peptic ulcers, adenocarcinoma
Autoimmune causes - symptoms of anaemia, anorexia,
What is peptic ulcer disease?
Ulceration through the gastric mucosa - must extend through muscularis mucosa.
Most common in first part of duodenum and lesser curve of the stomach
What causes peptic ulcer disease?
Mucosal injury from stomach acid, h pylori or NSAIDs
What are the symptoms of peptic ulcer disease?
Epigastric pain - burning, follows meals, worse at night with duodenal ulcers
Serious symptoms - bleeding, early satiety, weight loss
How is H pylori treated?
Triple therapy - PPI + clarithromycin + amoxicillin
What is Zollinger-Ellison syndrome?
A non beta islet cell gastrin secreting tumour of the pancreas
Causes proliferation of parietal cells so lots of acid produced leading to severe ulceration of stomach and small bowel
How common is stomach cancer?
What are the risk factors?
Very common - 3rd most common cancer in the world
Risk factors - male, h pylori, diet, smoking
