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Alimentary System > H. Pylori and Gastric Disease > Flashcards

H. Pylori and Gastric Disease Flashcards

1
Q

What is dyspepsia?

A

Indigestion/heartburn

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2
Q

What percentage of people presenting with dyspepsia will have no serious underlying disease?

A

80%

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3
Q

Give 5 typical presentations of common upper GI disorders

A 
Dyspepsia 
Retrosternal pain 
Anorexia 
Nausea 
Vomiting 
Bloating 
Fullness
Early satiety 
Abdominal pain
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4
Q

When should a referral for endoscopy be done in someone presenting with dyspepsia?

A

When there are alarms symptoms present

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5
Q

What are the alarms symptoms?

A

A - anorexia
L - loss of weight
A - anaemia, iron deficiency
R - recent onset, > 55 years of age or persistent despite treatment
M - melaena/haematemesis or abdominal mass
S - swallowing problems i.e. dysphagia

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6
Q

If a patient younger than 55 presents with dyspepsia, what should be done before an endoscopy/invasive investigation?

A

Test for H. pylori

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7
Q

What is gastritis?

A

Inflammation of the gastric mucosa

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8
Q

What are the three possible causes of gastritis?

A

Autoimmune
Bacterial
Chemical

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9
Q

What are the majority of peptic ulcers caused by?

A

H. pylori

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10
Q

What are two chemical causes of peptic ulcers?

A

Smoking

NSAIDs

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11
Q

Give three conditions which, rarely, can be responsible for peptic ulcers

A

Zollinger-Ellison syndrome
Hyperparathyroidism
Crohn’s disease

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12
Q

Give 5 clinical features of peptic/duodenal ulcers?

A 
Epigastric pain 
Nocturnal/hunger pain 
Back pain 
Nausea and vomiting 
Weight loss and anorexia 
Epigastric tenderness 
Haematemesis/melaena/anaemia
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13
Q

What might cause haematemesis, melaena or anaemia in a patient with a peptic or duodenal ulcer?

A

Haemorrhage of the ulcer

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14
Q

What are the possible treatments of peptic/duodenal ulcers?

A

Eradication therapy if caused by H. pylori
Antacid medication - PPIs or H2R antagonists
Stop NSAIDs if possible or give protective agents
Treat any arising complications
Surgery in complicated peptic ulcer disease

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15
Q

What are the possible complications of peptic/duodenal ulcers?

A 
Acute bleeding 
Chronic bleeding 
Perforation 
Fibrotic stricture 
Gastric outlet obstruction
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16
Q

What are the clinical features of a gastric outlet obstruction?

A 
Vomiting 
Early satiety 
Abdominal distension 
Weight loss 
Gastric splash 
Dehydration and loss of H and Cl ions due to vomiting 
Metabolic alkalosis 
Low Cl, Na, K and renal impairment
17
Q

What is the treatment of a gastric outlet obstruction?

A

Endoscopic dilation or surgery

18
Q

How is a H. pylori infection eradicated?

A

Triple therapy for 7 days
Clarithromycin - 500mg bd
Amoxycillin - 1g bd
PPI e.g. omeprazole - 20mg bd

If penicillin allergic:
Metronidazole - 400mg bd or tetracyclin

19
Q

What risk factors are associated with gastric cancer?

A

Smoking
High salt diet, food high in nitrates
H. pylori infection

20
Q

What is the main histological type of gastric cancer?

A

Adenocarcinoma

21
Q

What is the management of gastric cancer?

A

UGIE and biopsies
Staging investigations - CT chest/abdo
Surgical treatment and chemo
Palliative care

22
Q

What kind of organism is helicobacter pylori?

A

Gram negative

23
Q

What factors determine the outcome of a H. pylori infection?

A

Site of colonisation
Characters of the bacteria
Host factors

24
Q

What percentage of people infected with H. pylori will be asymptomatic or have chronic gastritis?

A

> 80%

25
Q

What percentage of people infected with H. pylori will have intestinal metaplasia or chronic atrophic gastritis?

A

15-20%

26
Q

What percentage of people infected with H. pylori will develop gastric cancer or MALT lymphoma?

A

< 1%

27
Q

H. pylori can only colonise what mucosa?

A

Gastric type mucosa

28
Q

What investigations are done to diagnose H. pylori?

A 
Serology - IgG against H. pylori 
Urea breath test 
Stool antigen test 
Gastric biopsy - histology and culture 
Rapid slide urease test
29
Q

What outcomes can chronic H. pylori infection lead to?

A

Antral predominant gastritis, increased acid and duodenal disease
Mild mixed gastritis with normal acid levels and no significant disease
Corpus predominant gastritis, decreased acid and gastric atrophy progressing to gastric cancer

Alimentary System (29 decks)

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