H. Pylori and Gastric Disease Flashcards
Dyspepsia
Pain or discomfort in the upper abdomen
Causes of dyspepsia
Peptic ulcer Gastritis Non ulcer dyspepsia Gastric cancer Hepatic causes Gallstones Pancreatic disease IBS Colonic cancer Coeliac disease Psychological Drugs Other systemic disease – metabolic, cardiac
When to refer for endoscopy
Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia
Helicobacter pylori
Gram negative, spiral-shaped, microaerophilic, flagellated bacteria
H. pylori colonises
Gastric type mucosa only
Why does H. pylori only colonise mucous layer
To avoid gastric contents
Non invasive diagnosis of H. pylori
Serology - IgG against H. pylori
Urea Breath Test
Stool antigen test
Invasive diagnosis of H. pylori
Requires endoscopy for culture or histology
Rapid slide urease test
Urease for diagnosis
H. pylori produce urease and so can be utilised in slide or breath tests
What is gastritis
Inflammation in the gastric mucosa
Types of gastritis
Autoimmune
Bacterial
Chemical
Autoimmune gastritis from
Parietal cells
Bacterial gastritis from
H. pylori
Chemical gastritis from
Bile/NSAIDs
Majority of peptic ulcers caused by
H. pylori infection, NSAIDs and smoking
GU
Gastric ulcer
DU
Duodenal ulcer
Symptoms of peptic ulcers
Epigastric pain Nocturnal/hunger pain Back pain Nausea and occasionally vomiting Weight loss and anorexia Haematemesis and/or melaena, or anaemia
Treatment of peptic ulcers
Eradication therapy to get rid of H. pylori
Antacid medication – proton pump inhibitors (omeprazole)or H2 receptor antagonists (ranitidine)
Cessation of NSAIDs if these are a factor
Eradication of H. pylori
Triple therapy for 7 days =>
Clarithromycin
Amoxycillin
PPI
Main complications of a peptic ulcer
Acute bleeding – melaena and haematemesis
Chronic bleeding – iron deficiency anaemia
Perforation
Fibrotic stricture (narrowing)
Gastric outlet obstruction – oedema or stricture
Gastric outlet obstruction symptoms
Vomiting – lacks bile, fermented foodstuffs
Early satiety, abdominal distension, weight loss, gastric splash
Dehydration and loss of H+ and Cl- in vomit
Metabolic alkalosis
Cause of gastric outlet obstruction
Cancer
Ulcer
Stricture
Treatment of gastric outlet obstruction
Endoscopic balloon dilatation
Surgery
Gastric cancer type
Adenocarcinoma - glandular epithelial cells
Presentation of gastric cancer
Dyspepsia Early satiety Nausea & vomiting Weight loss GI bleeding Iron deficiency anaemia Gastric outlet obstruction
Diagnosis of gastric cancer
Endoscopy and biopsies for a histological diagnosis
Treatment of gastric cancer
Surgery and chemotherapy
