H. Pylori and Gastric Disease Flashcards
what is dyspepsia
pain or discomfort in the upper abdomen:
- retrosternal pain
- heartburn
- early satiety
- fullness/bloating
- nausea and vomiting
- weight loss
upper GI causes of dyspepsia
ulcer, gastritis, gastric cancer
lower GI causes of dyspepsia
IBD, colon cancer, coeliac disease
what is anorexia
loss of appetite
what are red flag symptoms
Anorexia weight Loss Anaemia Recent onset Melaena/Haematemesis Mass Swallowing (dysphagia)
what acronym is used to remember the red flag symptoms
ALARMS
if someone presents with red flag symptoms what is the next step
refer for an endoscopy
what must someone have done all day before an endoscopy
have fasted (24 hours)
what lifestyle factors would you address in dyspepsia
smoking, alcohol, diet, exercise and weight loss
if someone presents with dyspepsia and NO red flag symptoms what factor determines whether or not you do an endoscopy
if they are over the age of 55
if someone presents under 55 y/o, dyspeptic, no red flag symptoms, what is the next step
test for H. Pylori
how prevalent is H. Pylori
~50%
H. Pylori is gram negative or positive
gram negative
what is the only type of mucosa that h. pylori can colonise
gastric
what proportion of h. pylori is asymptomatic or with mild gastritis
> 80%
what differs in the outcomes of h. pylori infection between being in the antrum and in the body
when in the antrum it causes increased acid and a risk of duodenal disease
when in the body the acid is reduced, gastric atrophy and a risk of gastric cancer
how can you non-invasively diagnose h. pylori infection
blood serum for IgG against h. pylori
urea breath test
stool antigen test
invasive diagnosis of h. pylori
endoscopy to gain a biopsy for culture, histology and rapid slide urease test
principle of urea breath test
labelled urea orally administered –> urea broken down by urease into ammonia and CO2 –> CO2 is labelled in breath and can be measured
what enzyme does h. pylori make in great quantities
urease
what is a CLO test
a rapid slide urease: biopsy of stomach is put on slide and it changes colour if h. pylori is present by urease breaking down the slide contents
what is a positive result on a CLO test
red
symptoms of peptic ulcer
epigastric pain nausea and vomiting weight loss loss of appetite haematemesis
what ulcer symptoms are more common in a duodenal ulcer
nocturnal or hunger pain
back pain
treatment of h. pylori caused ulcer
eradication therapy
eradication therapy
3 drugs for 7 days:
- clarithromycin
- amoxycillin
- proton pump inhibitor (reduce HCl)
what do PPIs like omeprazole do
inhibit the H+/K+ pump to reduce acid production
gastric outlet obstruction can be caused by the presence of…
oedema or a stricture
features of gastric outlet obstruction
vomit is fermented and has no bile early satiety abdominal distension weight loss gastric splash dehydration METABOLIC ALKALOSIS
how do you treat gastric outlet obstruction
with an endoscopic balloon dilatation or with surgery
how would you diagnose GOO
upper GI endoscopy
what does UGIE stand for
upper GI endoscopy
what would bloods in GOO show
low Cl, Na and K
what condition is zollinger-ellison syndrome a rare cause of
peptic ulcers
what is the 2nd commonest alimentary cancer
gastric cancer
gastric cancer has a good/poor prognosis
poor - 5 year <20%
presentation of gastric cancer
dyspepsia weight loss GI bleeding anaemia GOO
majority of gastric cancers are sporadic/hereditary
sporadic - <15% are familial
