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GI System > H Pylori and Gastric Disease > Flashcards

H Pylori and Gastric Disease Flashcards

1
Q

What are the 3 types of peptic ulcers?

A

Gastric Ulcers
Duodenal Ulcers
NSAIDs ulcers

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2
Q

What is dyspepsia?

A

Pain or discomfort in the upper abdomen

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3
Q

What 9 types of dyspepsia are there?

A

Upper abdomen discomfort, Retrosternal pain, Anorexia, Nausea, Vomiting, Heartburn, Bloating, Fullness & Early Satiety

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4
Q

What is the approach to dyspepsia?

A

Review meds
Lifestyle advice
Test for H. pyloria
Consider non-gastro-duodenal causes

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5
Q

When do you refer dyspepsia patients?

A 
Unexplained weight loss
Persistent vomiting
Iron def anaemia
Progressive dysphagia
Epigastric mass
Abnormal imaging
>55 years with persistent dyspepsia
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6
Q

What is dysphagia?

A

Difficulty swallowing

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7
Q

Are peptic ulcers more common in men or women?

A

Men

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8
Q

How are peptic ulcers caused?

A

Imbalance between the damaging effect of acid/pepsin and the protective effect of mucosal defences such as mucus, bicarbonate and prostaglandins

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9
Q

What hormone increases when the food hits the stomach?

A

Gastrin

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10
Q

What anti-platelet drug can cause NSAID ulcers?

A

Aspirin

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11
Q

What are the clinical features of peptic ulcers?

A 
Main feature - Epigastric pain
Nocturnal/hunger pain
Back pain
Nausea
Anorexia and Weight loss
Haematemesis and/or Malaena or Anaemia if ulcer bleeds
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12
Q

What is haematemesis?

A

Vomiting blood

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13
Q

What is melaena?

A

Partly digested blood in the faeces

Very offensive

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14
Q

What blood tests should be done for peptic ulcers?

A

H. pylori serology

FBC

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15
Q

Apart from blood tests, what other investigation should be done for peptic ulcers?

A

Urea breath test
Upper GI endoscopy - Biopsy of gastric ulcers to exclude malignancy
Barium studies - Not commonly done now

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16
Q

Are ulcers in the duodenum malignant or benign?

A

Benign

17
Q

Why does H. pylori grow well in children?

A

They produce less acid so thus the environment isn’t harsh to thrive in

18
Q

What conditions are associated with H. pylori infections?

A

Gastritis
Pectic ulcer disease
Gastric neoplasia
Non-ulcer dysplasia

19
Q

How does a urease test work?

A

Patient will breath out either Carbon Dioxide or Ammonia and if H. pylori is present the CLO test slide will change colour

20
Q

What parts of stomach does H. pylori colonise and what effect does this have?

A

Only the gastric type mucosa residing in the surface mucous layer - Doesn’t penetrate the epithelial layer
Causes powerful inflammatory reaction which becomes chronic

21
Q

How does the stomach become messy?

A

If inflammation occurs in the acid producing part of the stomach - Acid secretions start to decrease

22
Q

What is most likely to result from an H. pylori infection in the antrum of the stomach?

A

Duodenal Ulcer disease

23
Q

What is most likely to result from an H. pylori infection in the corpus (Fundus + Body) of the stomach?

A

Gastric Cancer

24
Q

What happens in Duodenal Ulcer Disease (DUD)?

A

Increased duodenal acid load leading to:

Gastric metaplasia, HP colonisation & Ulceration

25
Q

What happens when there is an increased acid response to gastrin?

A

Increased parietal cell mass

Sensitivity is unimpaired because of the absence of corpus gastritis

26
Q

What causes an increased Gastrin release?

A

Decreased in somatostatin and CagA+ve is greater than CagA-ve

27
Q

Eradicating H.pylori causes what four things?

A

Gastrin levels to return to normal
Reduced acid secretion in the corpus
Normalisation of gastrin and somatostatin in the antrum
Decreased acid load and increased bicarbonate in the duodenum

28
Q

When should surgery be done for PUD?

A

Only in complicated cases

29
Q

how long should H. pylori eradication drugs be used for and what three should be prescribed?

A

Clarithromycin 500mg bd
Amoxycillin 1g bd
Tetracycline if penicillin allergy
PPI

30
Q

7 indications for H. pylori disease?

A 
Patient wishes - Anxiety
Peptic ulcer disease
MALT lymphoma
Non-ulcer dyspepsia
FDR of gastric cancer patient
Long-term use of PPI therapy
31
Q

What are the possible complications of Peptic ulcers?

A

Perforation
Acute Bleeding
Ulcer in the pylorus may scar

32
Q

What surgery may be required if there is an ulcer that has scarred in the pylorus?

A

Balloon dilatation

GI System (38 decks)

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