GI: Conditions of the Stomach + Duodenum Flashcards
What are the functions of the stomach?
Emulsification of fat + mechanical breakdown of food
A reservoir for food
Secretion of intrinsic factor (needed for absorption of vitamin B12)
Secretion of gastric acid from parietal cells in the fundus
What is the role of gastric acid?
Begins process of protein digestion + protective role by destroying bacteria
What increases gastric acid secretion?
Stimulation of the vagus nerve, histamine and gastrin
What decreases gastric acid secretion?
Somatostatin release from antral D cells
What kind of organism is H.Pylori?
A gram negative urease producing spiral shaped bacterium
Where is H.Pylori predominately found?
Gastric antrum + areas of gastric metaplasia
By what route is H.Pylori transferred?
Oral- Oral
Faecal- Oral
What is the management for H.Pylori infection?
Management aimed at eradication.
PPI based triple therapy:
Omeprazole + Amoxicillin/Metronidazole + Claritromycin twice daily for 7 days
How is H.Pylori infection diagnosed?
C urea breath test
Rapid urease test (CLO) (invasive)
gastric mucosal biopsy (invasive)
Are duodenal or gastric ulcers more common?
Duodenal ulcers
What causes peptic ulcer disease?
H.Pylori
NSAIDS
Aspirin
What is the classic presentation of a gastric ulcer?
Burning epigastric pain made worse by eating
What is the classic presentation of a duodenal ulcer?
Burning epigastric pain relieved by eating + worse at night
What is the investigation of choice for patients under 55 with symptoms of peptic ulcer disease?
Urea breath test for H.Pylori infection
Alongside a urease breath test, what other investigation is done for patients over 55 with symptoms of peptic ulcer disease?
Endoscopy to check for malignancy
What is the management for H.Pylori associated ulcers?
PPI based triple therapy.
Eradication confirmed with urea breath test/stool antigen test
What is the management for H.Pylori negative ulcers?
PPIs. Stop NSAIDs/Aspirin
What are some complications of peptic ulcer disease?
Perforation- Duodenal ulcers more commonly than gastric
Gastric outlet obstruction due to oedema/scarring after healing
What are the signs/symptoms of a gastric outlet obstruction?
Projectile vomiting, Succussion splash. Metabolic alkalosis due to acid loss
What is gastropathy?
Injury to the gastric mucosa associated with epithelial damage and regeneration- little/no inflammation.
What causes gastropathy?
NSAIDs + aspirin: depletion of mucosal prostaglandins by inhibiting COX pathway
Other less common causes include herpes simplex, cytomegalovirus and excessive alcohol use
What are the symptoms of gastropathy?
Indigestion, vomiting blood
Erosions + sub endothelial haemorrhages seen on biopsy
How is gastropathy treated?
PPIs
What is gastritis?
Inflammation of the gastric mucosa
What is the commonest cause of gastritis?
H.Pylori
What is seen in an acute gastritis biopsy?
neutrophilic inflammation
What is seen in a chronic gastritis biopsy?
Lymphocytes, plasma cells, macrophages
Which is the most common gastric cancer and where is it most commonly found?
Adenocarcinoma
The antrum
What does Virchows Node indicate?
GASTRIC CANCER
node felt in supraclavicular fossa
What are the two types of gastric cancer?
Type 1- ulcerative lesion with rolled edges
Type 2- diffuse with extensive submucosal spread
What are the symptoms of gastric cancer?
Early satiety, epigastric pain/mass, anorexia, nausea, weight loss
What are the primary investigations for gastric cancer?
Endoscopy + biopsy
