H Pylori

Question 1

Where can H pylori only colonise

Answer 1

Gastric type mucosa

Question 2

What’s is the enzyme generated to raise PH

Answer 2

Urease

Question 3

Though not typically invasive, what cell do they specifically enter

Answer 3

Immune cells

Question 4

What are the outcomes of infection

Answer 4

Most asymptomatic
15-20% chronic strophic gastris, gastric or duodenal ulcer
1% gastric cancer

Question 5

What is the out come of an infection dependent on

Answer 5

Site of colonisation
Characterisation of bacteria (strain)
Genetic susceptibility
Environment like smoke

Question 6

If an infection is in the antral, what will this lead to

Answer 6

Duodenul ulcer disease

Question 7

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

Answer 7

High acid

Question 8

Where does h pylori establish an infection which results in low acidic production therefore high risk of gastric atrophy

Answer 8

Corpus

Question 9

If there is a mild mixed gastris , what will the acid be

Answer 9

Normal acid , balance each other out

Question 10

What are the non invasive tests for H pylori

Answer 10

Serology, IgG
13C/14C urea breath test
Stool antigen test ELISA, Need to be off PPI for 2 weeks

Question 11

What are invasive test

Answer 11

Histology, culture, and rapid slide urease test which require endoscopy

Question 12

What is gastritis

Answer 12

Inflammation in the gastric muscosa caused by ABC

Question 13

Do peptic ulcers effect women or men more

Answer 13

Men more

Question 14

A patient present with Peptic ulcer, In order of most likely list the different causes

Answer 14

H pylori
NSAIDs, smoking
Zollinger Ellison syndrome, hyperparathyroidsim, crohns

Question 15

What are the clinical symptoms of peptic ulcer

Answer 15

Epigastric pain main feature which may be relived with antacids 
Nocturnal or hunger pain 
Back pain 
Nausea, vomitting occasitionally
If bleeds, anaemia, haematemesis

Question 16

What are signs which would suggest an ulcer is DU

Answer 16

Back pain

Nocturnal or hunger pain

Question 17

How do you treat peptic ulcer

Answer 17

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

Question 18

How do you eradicate an H.pylori infection

Answer 18

Triple therapy for 7 days

1) Clarithtomycin 500mg
2) amoxicillin 1g/ metronidazole 400mg
3) PPI for omeprazole 20 mg

Question 19

What are the complications of peptic ulcer

Answer 19

Acute bleeding 
Chronic bleeding leading to iron def
Perforation 
Fibrotic stricture
Gastric outlets obstruction leading to oedema or stricture

Question 20

What are the symptoms of gastic outlet obstruction

Answer 20

Vomiting which lacks bile
Dehydration 
Loss of HCl in vomit 
Metabolic alkalosis 
Bloods show lo Cl, low Na, low K

Question 21

How is a gastric outlet obstruction treated

Answer 21

UGIE = prolonged fast/ aspiration of basic contents

Question 22

How is a gastric outlet obstruction treated

Answer 22

Endoscopic balloon dilatation

Surgery

Question 23

What are the different gastric cancer types

Answer 23

Adenocarcinoma
MALT
GIST

Question 24

What is the Correa hypothesis

Answer 24

Multipl mutations over time

Question 25

Describe the genetic pattern for gastric cancer

Answer 25

Majority are sporadic
<15% familial
1-3% heritable, HDGC is autosomal dominant , CDH1 gene