H. pylori and Gastric Disease Flashcards
What is the dyspepsia?
Pain or discomfort in the upper abdomen
What symptoms are considered dyspepsia?
Upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn
What Upper GI problems can cause dyspepsia?
Peptic ulcer, gastritis, non-ulcer and gastric cancer
What other causes (apart from upper GI) can cause dyspepsia?
Hepatic causes, gallstones, pancreatic disease, lower GI (IBS, colonic & cancer), coeliac disease, drugs, psychological and other systemic disease
With regard to dyspepsia when should the patient be referred to endoscopy?
A-anorexia
L-loss of weight
A - anaemia
R - recent onset, over 55yrs and persistent despite treatment
M - Melaena/haematemesis (GI bleeding) or mass
S - Swallowing problems
What are the main features of helicobacter pylori?
Gram negative, spiral-shaped, microaerophilic and flagellated
What effect does H. pylori on the mucosal layer of the stomach?
It resides in the surface of the mucosa and evokes an immune response
What consequence does increased acid have on the antrum of the stomach?
Duodenal Ulcers
What consequence does increased acid have on the corpus of the stomach?
Gastric Cancer
What are the investigations used to diagnose H. pylori infection?
Serology, stool antigen test and endoscopy (biopsy)
What is gastritis?
Inflammation in the gastric mucosa
What are the causes of peptic ulcers?
H. pylori, NSAIDS and smoking
What symptoms are associated with peptic ulcers?
Epigastric pain, nocturnal/hunger pain, back pain, nausea/vomiting, weight loss/anorexia, haematemesis/melaena and anaemia
What is the treatment for a peptic ulcer?
Antacid medication - Proton Pump Inhibitors (Omeprazole)
What is the eradication therapy for H. pylori infection?
Clarithromycin - 500mg bd
Amoxycillin - 1g bd
PPI e.g. omeprazole 20mg bd
What are the complications of a peptic ulcer?
Acute bleeding - melaena & haematemesis
Chronic bleeding - iron deficiency anaemia
Perforation
Fibrotic Stricture (narrowing)
Gastric Outlet Obstruction - oedema or stricture
What are the signs and symptoms of gastric outlet obstruction?
Vomiting, early satiety, abdominal distension, weight loss, gastric splash, dehydration, metabolic alkalosis
What blood results are associated with gastric outlet obstruction?
Low Cl, low Na, low K and renal impairment
What investigation is used to diagnose gastric outlet obstruction?
UGIE
What is the treatment for gastric outlet obstruction?
Endoscopic balloon dilatation and surgery
What are the symptoms of gastric cancer?
Dyspepsia, early satiety, nausea/vomiting, weight loss, GI bleeding, iron deficiency, anaemia and gastric outlet obstruction
What are the causes of gastric cancer?
Diet, genes, smoking, ulcers, FH, previous gastric resection, biliary flux and premalignant gastric pathology
What is the management of a patient with gastric cancer?
Staging investgations, MDT discussion and treatment (surgical and chemotherapy)
