GI - stomach Flashcards
what is GORD
reflux of acid and bile from stomach due to reduced LOS tone
can also be caused by
=> reduced barrier function
=> increased visceral sensitivity in the oesophagus
=> poor oesophageal clearence
what can prolonged reflux lead to
oesophagi's benign oesophageal strictures barrett's oesophagus haemorrhage adenocarcinoma
typical s/s GORD
heart burn chest pain water brash dysphagia odynophagia acid reflux weight loss damage to enamel adult onset asthma and cough laryngitis
what are some risk factors of GORD
alcohol tobacco obesity caffeine hiatus hernia age, family history
main investigate for GORD
endoscopy
what are some lifestyle treatments of GORD
lose weight / stop smoking / avoid alcohol/fatty foods/chocolate/peppermint
small regular meals
what are some drug treatments of GORD
antacids (symptomatic)
PPIs (symptomatic and healing)
when is surgery indicated in GORD and what does it aim to do
when PPIs ineffective
aims to increase resting lower oesophageal sphincter pressure
what is gastroparesis
delayed gastric emptying (not due to obstruction)
typical s/s of gastroparesis
fullness/bloating
nausea and vomiting
weight loss
upper abdo pain
what are some causes of gastroparesis
diabetes
weed
opiates
systemic diseases e.g. systemic sclerosis
what are the treatments of gastroparesis
remove cause liquid / low fat diet small meals promotability agents e.g. domperidone, metoclopramide Gastric pacemaker nutritional support
what are some causes of acute gastritis
chemical insult severe burn NSAIDs Heavy alcohol consumption chemotherapy head injury - increased ICP - increased stimulation of vagus nerve - increased acid production
gastritis is acidic damage to stomach mucosa due to imbalance in what
mucosal defence and acidic environment
—> superficial inflammatory erosion/peptic ulcer
s/s gastritis
epigastric pain bloating fullness heart burn tenderness
ALARMS s/s gastritis
A - anaemia L - loss of weight A - anorexia R - recent onset/progressive M - melenia/haematemesis S - swallowing difficulty
what is chronic gastritis
chronic inflammation of the stomach mucosa
what are 2 causes of chronic gastritis
autoimmune
H. Pylori
what is the pathophysiology of autoimmune gastritis
autoimmune antibodies against parietal cells and intrinsic factor located in stomach body and fundus
what is autoimmune gastritis mediated by
T cells
what type of hypersensitivity is autoimmune gastritis
type IV hypersensitivity
what is a common complication of autoimmune gastritis
pernicious anaemia - loss of intrinsic factor
what are some s/s of pernicious anaemia
lethargy/weakness dyspnoea sore tongue mild jaundice diarrhoea
how can pernicious anaemia be treated
3 monthly injections of VB12
folic acid supplements
what can autoimmune gastritis predispose to
gastric carcinoma
where does H. Pylori reside
between epithelial cell surface and mucosal barrier
most commonly in antrum
H. Pylori is …
gram negative
bacilli (comma shaped rods)
oxidase and catalase positive
what is the effect of H. Pylori
increase in secretion of gastrin from G cells which increases HCl secretion —> peptic ulcers
H. Pylori increases the risk of ….
ulceration
gastric adenocarcinoma
MALT lymphoma
what is the test for H. Pylori
(13C) urea breath test (urease breath test)
or stool antigen test or serology
if someone comes in with the symptoms of gastritis that is under 55 what should be tone
test for H. Pylori
if someone comes in with symptoms of gastritis that is over 55 / has ALARMS s/s what should be done
or treated for H. Pylori and symptoms don’t improve
Upper GI endoscopy / gastroscopy
what is the treatment for H. Pylori
PPI + 1g Amoxicillin BD + Clarithromycin 500mg BD
penicillin allergic –>
PPI + 400mg Metronidazole BD + clarithromycin 250mg BD
how long should H. Pylori treatment be stopped before retest
2 weeks
what are the 2 most common sites of peptic ulcers
proximal duodenum (90%) distal stomach (10%)
epigastric pain that improves with meals, is felt usually 2-3 hours after a meal and often wakes patients at night is most likely a ….
duodenal ulcer
what is the most common cause of duodenal ulcer
H. Pylori
Epigastric pain that is felt shortly after meals and may radiate to back is most likely a ….
gastric ulcer
what are some causes of gastric ulcers
H. Pylori NSAIDs reflux of duodenal bile content delayed epigastric emptying increased acid secretion/failure of mucosal defence
where in the stomach are gastric ulcers usually found
lesser curvature
what is the treatment for peptic ulcers
PPI (lansoprazole)
H2RAs (ranitidine)
Antacid (Gaviscon)
how are peptic ulcers diagnosed
test for H. Pylori
upper GI endoscopy - stop PPI for 2 weeks
what are some complications of peptic ulcers
bleeding --> anaemia perforation malignancy (rare) gastric outflow obstruction fibrosis --> stenosis intractable pain
what is seen in the microscopy of peptic ulcers
clear cut edges, punched out layered: floor - necrotic fibrinopurulent debris base - inflamed granulation tissue deepest layer - fibrotic scar tissue
what would large and irregular edges indicate
cancer
what are peptic ulcers
breach of GI mucosa
what is the rome III criteria of functional dyspepsia
atleast one of following for 3 months with symptom onset 6 months prior to diagnosis
- epigastric pain or burning
- post prandial fullness
- early satiety
+ no evidence of structural disease
what is the most common cause of functional dyspepsia
IBS/GORD overlap
what are some organic causes of dyspepsia
H. Pylori
NSAIDs/COX2
gastric cancer
peptic ulcers - most common
what is the treatment/diagnosis of dyspepsia
in absence of RFs check for H. Pylori
if HP negative –> acid inhibition
when should PPIs be taken
30 mins before a meal so they can begin function by the time meal is consumed
A person comes to GP with epigastric tenderness/burning, a palpable mass in the epigastric region and postprandial fullness. what could it be?
Dyspepsia
