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Systems: Alimentary AB > H Pylori and Gastric Disease > Flashcards

H Pylori and Gastric Disease Flashcards

1
Q

What are the 2 main components of the upper GIT?

A
  • Oesophagus

- Stomach

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2
Q

What are the 2 main components of the lower GIT?

A
  • Small intestine

- Large intestine

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3
Q

What are the functions of the stomach?

A
  • Food storage
  • Initial digestive processes
  • Acidic environment
  • Secretion
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4
Q

What does the stomach secrete?

A
  • Gastric acid
  • Gut hormones
  • Intrinsic factor
  • Pepsin
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5
Q

What does dyspepsia literally mean?

A

-Bad digestion

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6
Q

What does dyspepsia describe?

A

A group of symptoms

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7
Q

What symptoms are classed as dyspepsia?

A
  • Pain or discomfort in the upper abdomen
  • Retrosternal pain
  • Anorexia
  • Nausea
  • Vomiting
  • Bloating
  • Fullness
  • Early satiety
  • Heartburn
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8
Q

Organic

A

Relating to or rising in a bodily organ

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9
Q

Functional

A

Impairment of a normal body function when everything looks normal

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10
Q

What upper GI causes of dyspepsia are there?

A
  • Peptic ulcer
  • Gastritis
  • Non ulcer dyspepsia
  • Gastric cancer
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11
Q

What can cause dyspepsia other than the upper GIT?

A
  • Hepatic causes
  • Gallstones
  • Pancreatic disease
  • Lower GI
  • Coeliac disease
  • Other systemic disease
  • Drugs
  • Psychological
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12
Q

What lower GIT causes of dyspepsia are there?

A
  • IBS

- Colonic cancer

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13
Q

What are the red flag symptoms for referral to endoscopy?

A
  • Anorexia
  • Loss of weight
  • Anaemia
  • Recent onset >55 years or persistent despite treatment
  • Melaena/haematemesis or mass
  • Swallowing problems
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14
Q

What is involved in an upper GI endoscopy?

A
  • Diagnosis/therapeutic
  • Local anaesthetic or sedation
  • Day case
  • Fasted
  • Consent
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15
Q

What are the risks of upper GI endoscopy?

A
  • Perforation
  • Bleeding
  • Reaction to drugs
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16
Q

What is key when a patient presents with dyspepsia?

A

History and examination

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17
Q

What bloods should be carried out when a patient presents with dyspepsia?

A
  • FBC
  • Ferritin
  • LFT
  • U+E
  • Calcium
  • Glucose
  • Coeliac serology
  • Serum IgA
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18
Q

What drugs are important in the history of someone with dyspepsia?

A 
-NSAIDs
Steroids
-Bisphosphonate
-Ca antagonists
-Nitrates
-Theophylline
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19
Q

What is important to ask about lifestyle in the history od someone with dyspepsia?

A
  • Alcohol
  • Diet
  • Smoking
  • Exercise
  • Weight reduction
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20
Q

What are the characteristics of helicobacter pylori?

A
  • Gram negative
  • Spiral shaped
  • Microaerophilic
  • Flagellated
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21
Q

When is H pylori usually acquired?

A

Childhood

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22
Q

What is the only type of mucosa that H pylori can colonise?

A

Gastric

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23
Q

Where does H pylori reside?

A

In the surface mucous layer and does not penetrate the epithelial layer

24
Q

What does H pylori do to the underlying mucosa?

A

Evokes an immune response

25
Q

What are the clinical outcomes of H pylori infection?

A
  • Asymptomatic or chronic gastritis
  • Chronic atrophic gastritis intestinal metaplasia
  • Gastric or duodenal ulcer
  • Gastric cancer MALT lymphoma
26
Q

What are the outcomes of H pylori infection dependent on?

A
  • Site of colonisation
  • Characteristics of bacteria
  • Host factors
27
Q

Give 2 brackets of host factors.

A
  • Susceptibility

- Environmental

28
Q

Describe the response to antral predominant gastritis by chronic H pylori infection

A
  • Increase in acid
  • Low risk of gastric cancer
  • Duodenal disease
29
Q

Describe the response to corpus predominant gastritis by chronic H pylori infection.

A
  • Decrease in acid
  • Gastric atrophy
  • Gatric cancer
30
Q

Describe the response to mild mixed gastritis by chronic H pylori infection.

A
  • Normal acid

- No significant disease

31
Q

What are the non-invasive ways of diagnosing H pylori infection?

A
  • Serology: IgG against H pylori
  • 13c/14c urea breath test
  • Stool antigen test: ELISA: need to be off PPI for 2 weeks
32
Q

What are the invasive ways of diagnosing H pylori infection?

A

Requires endoscopy

  • Histology: gastric biopsies stained for bacteria
  • Culture of gastric biopsies
  • Rapid slide urease test (CLO)
33
Q

What is it that is utilised in slide urease tests?

A

Ammonia

34
Q

What is gastritis?

A

Inflammation in the gastric mucosa

35
Q

How is gastritis diagnosed?

A
  • Histological diagnosis

- Clinical features seen at endoscopy

36
Q

What are the 3 types of gastritis?

A
  • Autoimmune (protein produced by stomach against parietal cells)
  • Bacterial (H pylori)
  • Chemical (bile/NSAIDs)
37
Q

What is the prevalence of peptic ulcers?

A
  • DU>GU
  • Men>women
  • Elderly
38
Q

What are the majority of peptic ulcers caused by?

A

H pylori infection

39
Q

What other causes of peptic ulcers are there?

A
  • NSAIDs
  • Smoking
  • Other conditions (Zollinger-Ellison syndrome, hyperparathyroidism, Crohn’s disease)
40
Q

What symptoms are associated with peptic ulcer?

A
  • Epigastric pain
  • Nocturnal/hunger pain
  • Back pain
  • Nausea and occasionally vomiting
  • Weight loss and anorexia
  • Haematemesis/maelena/anaemia if ulcer bleeds
41
Q

What is the treatment for peptic ulcers?

A
  • H pylori caused= eradication therapy
  • Antacids: PPI or H2 antagonists
  • NSAID caused= stopped
  • Complications treated as they arise
  • Surgery only if perforated
42
Q

What does eradication therapy for H pylori include?

A

Triple therapy for 7 days

  • Clarithromycin 500mg bd
  • Amoxycillin 1g bd
  • PPI
43
Q

What are the main reasons fro failure of triple therapy?

A
  • Resistance to antibiotics

- Poor compliance

44
Q

What are the complications of peptic ulcer?

A
  • Acute bleeding (haematemesis/maelena)
  • Chronic bleeding (anaemia)
  • Perforation
  • FIbrotic stricture
  • Gastric outlet obstruction (oedema/stricture)
45
Q

What are the symptoms of gastric outlet obstruction?

A
  • Vomiting (lacks bile, fermented foodstuffs)
  • Early satiety
  • Abdominal distension
  • Weight loss
  • Gastric splash
46
Q

What does vomiting lead to?

A

Dehydration

47
Q

Why does metabolic alkalosis occur with gastric outlet obstruction?

A

Loss of H and Cl in vomit

48
Q

What would show up in the bloods of someone with gastric outlet obstruction?

A
  • Low Cl
  • Low Na
  • Low K
  • Renal impairment
49
Q

How is gastric outlet obstruction diagnosed?

A
  • UGIE (prolonged fast/aspiration of gastric contents)

- Identify cause (stricture, ulcer, cancer)

50
Q

How is gastric outlet obstruction treated?

A
  • Endoscopic balloon dilatation

- Surgery

51
Q

What are the majority of gastric cancers?

A

Adenocarcinomas (MALT/GIST)

52
Q

How do patients with gastric cancer present?

A
  • Dyspepsia
  • Early satiety
  • Nausea and vomiting
  • Weight loss
  • GI bleeding
  • Iron deficiency anaemia
  • Gastric outlet obstruction
53
Q

What is the aetiology of gastric cancer?

A
  • Diet
  • Genetics
  • Smoking
  • H pylori infection
54
Q

Give an example of a heritable gastric cancer syndrome?

A

HDGC: AD CDH-1 gene (E-cadherin)

55
Q

How is a histological diagnosis of gastric cancer made?

A

Endoscopy and biopsy

56
Q

What staging investigations are carried out with gastric cancer?

A
  • CT chest/abdo

- MDT meeting

57
Q

What is the treatment for gastric cancer?

A
  • Surgery

- Chemotherapy

Systems: Alimentary AB (37 decks)

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