H Pylori Flashcards
Where can H pylori only colonise
Gastric type mucosa
What’s is the enzyme generated to raise PH
Urease
Though not typically invasive, what cell do they specifically enter
Immune cells
What are the outcomes of infection
Most asymptomatic
15-20% chronic strophic gastris, gastric or duodenal ulcer
1% gastric cancer
What is the out come of an infection dependent on
Site of colonisation
Characterisation of bacteria (strain)
Genetic susceptibility
Environment like smoke
If an infection is in the antral, what will this lead to
Duodenul ulcer disease
If there is an infection in the antral is acid high or low which is resulting in DU disease but low risk to gastric chronic atrophy
High acid
Where does h pylori establish an infection which results in low acidic production therefore high risk of gastric atrophy
Corpus
If there is a mild mixed gastris , what will the acid be
Normal acid , balance each other out
What are the non invasive tests for H pylori
Serology, IgG
13C/14C urea breath test
Stool antigen test ELISA, Need to be off PPI for 2 weeks
What are invasive test
Histology, culture, and rapid slide urease test which require endoscopy
What is gastritis
Inflammation in the gastric muscosa caused by ABC
Do peptic ulcers effect women or men more
Men more
A patient present with Peptic ulcer, In order of most likely list the different causes
H pylori
NSAIDs, smoking
Zollinger Ellison syndrome, hyperparathyroidsim, crohns
What are the clinical symptoms of peptic ulcer
Epigastric pain main feature which may be relived with antacids Nocturnal or hunger pain Back pain Nausea, vomitting occasitionally If bleeds, anaemia, haematemesis
What are signs which would suggest an ulcer is DU
Back pain
Nocturnal or hunger pain
How do you treat peptic ulcer
1) antacid: proton pump inhibitor (omeprazole)
2) stop NSAIDs
3) eradication therapy of cause is infective which it most likely is if you were paying attention
4) surgery for complications
How do you eradicate an H.pylori infection
Triple therapy for 7 days
1) Clarithtomycin 500mg
2) amoxicillin 1g/ metronidazole 400mg
3) PPI for omeprazole 20 mg
What are the complications of peptic ulcer
Acute bleeding Chronic bleeding leading to iron def Perforation Fibrotic stricture Gastric outlets obstruction leading to oedema or stricture
What are the symptoms of gastic outlet obstruction
Vomiting which lacks bile Dehydration Loss of HCl in vomit Metabolic alkalosis Bloods show lo Cl, low Na, low K
How is a gastric outlet obstruction treated
UGIE = prolonged fast/ aspiration of basic contents
How is a gastric outlet obstruction treated
Endoscopic balloon dilatation
Surgery
What are the different gastric cancer types
Adenocarcinoma
MALT
GIST
What is the Correa hypothesis
Multipl mutations over time
Describe the genetic pattern for gastric cancer
Majority are sporadic
<15% familial
1-3% heritable, HDGC is autosomal dominant , CDH1 gene
