H Pylori and Gastric Disease Flashcards
1
Q
Definition of dyspepsia
A
Pain or discomfort in the upper abdomen
2
Q
Symptoms of dyspepsia
A
Upper abdominal discomfort Heartburn Retrosternal pain Anorexia - lack of appetite Nausea Vomiting Cough Bloating Fullness Early satiety Poor dentition
3
Q
What % of people get dyspepsia?
A
80%
4
Q
Two types of causes of dyspepsia
A
Organic
Functional
5
Q
Definition of organic
A
There is a specific pathology driving the symptoms
6
Q
Definition of functional
A
Structurally things are okay but its functioning / the perception isn’t functioning as good
7
Q
Causes of dyspepsia
A
Peptic ulcer Gastritis Non ulcer dyspepsia (functional) Gastric cancer Hepatic causes Gallstones Pancreatic disease IBS Colonic cancer Coeliac disease Other systemic diseases e.g. metabolic, cardiac Drugs Psychological
8
Q
When to refer for an endoscopy if have dyspepsia and how is this remembered?
A
ALARMS
- anorexia
- loss of weight
- anaemia
- recent onset / > 55 years / persistent despite treatment
- melena/haematemesis
- swallowing problems - dysphagia
9
Q
Definition of melena
A
Black sticky stool (blood)
10
Q
Definition of haematemesis
A
The vomiting of blood
11
Q
What do melena and haematemesis both indicate?
A
Upper GI blood loss
12
Q
Complications of upper GI endoscopy and how often do these occur?
A
Perforation
Bleeding
Reaction to drug
1:2000
13
Q
Where does upper GI endoscopy visualise?
A
Oesophagus down to the second part of duodenum
14
Q
Investigations for a patient presenting with dyspepsia
A
Exam - mass FBC, ferritin - anaemia LFTs U and Es Calcium (high Ca can drive dyspepsia) Glucose Coeliac serology / serum IgA Endoscopy Oesophageal pH studies Mammometry
15
Q
What drugs can be related to dyspepsia?
A
NSAIDs Steriods Biphosphonates Ca antagonists Nitrates Theophyllines OTT
16
Q
What is gastritis?
A
Inflammation of the gastric mucosa
17
Q
What therapy is done is H pylori +ve?
A
Eradication therapy
Symptomatic treatment
18
Q
Two types of peptic ulcers
A
Gastric ulcer
Duodenal ulcer
19
Q
What are the majority of peptic ulcers caused by?
A
H pylori
20
Q
Causes of peptic ulcers
A
H pylori Smoking NSAIDs Zollinger-Ellison syndrome Hyperparathyroidism Crohn's disease
21
Q
Which gender gets peptic ulcers more?
A
M > W
22
Q
Which type of ulcer is more common?
A
DU > GU
23
Q
Symptoms associated with a peptic ulcer
A
Epigastric pain (main feature) Nocturnal hunger/pain (more common in DU) Pain relieved by eating (DU) / worse by eating (GU) Back pain (penetration of posterior DU) Nausea Occasional vomiting Weight loss and anorexia Epigastric tenderness
24
Q
If a peptic ulcer bleeds, what symptom may the patient present with?
A
Haematemsesis and or melena or anaemia
25
How do antacids work?
Reduce the acid and this stops the acid irritating the denuded area and allows the mucosal layer to heal in ulcers
26
Why would especially older patients need an endoscopy if have an ulcer?
Ulcers can have cancer cells
27
Treatment of peptic ulcers
```
H pylori eradication therapy
Antacid medication
- PPI - omeprazole
- H2 receptor antagonists - ranitidine
Stop NSAIDs
Surgery only in complicated PUD i.e. if have made hole in duodenum
```
28
What does PPI stand for?
Proton pump inhibitors
29
Complications of peptic ulcers
Acute bleeding - melena and haematemesis
Chronic bleeding - iron deficiency anaemia
Perforation
Fibrotic stricture/narrowing
Gastric outlet obstruction (oedema or stricture)
30
Why would a stricture form after a peptic ulcer?
Ulcer heals with scar tissue which causes narrowing in the lumen which then leads to obstruction
31
Presentation of gastric outlet obstruction
```
Vomiting
- lacks bile
- fermented foodstuffs
Early satiety
Abdominal distention
Weight loss (metabolic malabsorption)
Gastric splash
Dehydration
Loss of H+ and Cl- in vomit
Metabolic alkalosis
Low K and Na- renal impairment
```
32
Diagnosis of gastric outlet obstruction
Endoscopy - UGIE
33
Treatment of gastric outlet obstruction
Endoscopic balloon dilatation
| Surgery
34
Prognosis of gastric cancer
5 year survival < 20%
35
Types of gastric tumours
Adenocarcinoma
MALT
GIST
36
Most common type of gastric cancer
Adenocarcinoma
37
Presentation of gastric cancer
```
Dyspepsia
Early satiety
Nausea and vomiting
GI bleeding
Weight loss
Iron deficiency anaemia
Gastric outlet obstruction
```
38
Risk factors for gastric cancer
```
Molecular aspects
Smoking
High salt diet / foods high in nitrates
FH
Previous gastric resection
Biliary reflux
Premalignant gastric pathology
H pylori infection
```
39
What % of gastric cancers are inherited?
< 15% familial clustering
| 1 - 3% heritable gastric cancer syndrome (HDGC, AD, CHD-1 gene)
40
Investigations for gastric cancer
Endoscopy
Biopsy
Staging imaging investigations (CT)
41
Treatment for gastric cancer
Surgery
| Chemotherapy
42
What does H pylori look like?
Spiral shaped
Microaeorphillic
Flagellated
43
When do most people acquire H pylori?
Childhood
44
Where is the only place H pylori can colonise? Where here does it reside? Does it penetrate the epithelial layer?
Gastric type mucosa
Surface mucus layer
No
45
What does H pylori promote?
Immune response in lining of the GI tract
46
Outcome of H pylori infection depends on.....
Size of colonisation
Characteristics of bacteria
Host factors e.g. genetics
Environmental factors e.g. smoking
47
Possible outcomes of H pylori infections
Nothing
Gastritis
Ulcers
Role in gastric cancer
48
What are you more likely to develop in the antrum of the stomach due to H pylori and why?
Ulcer
| As acid is increased
49
What are you more likely to develop in the corpus/body of the stomach due to H pylori infection and why?
Gastric cancer
| Less acid and so changes the cells
50
Investigations for H pylori infection
```
Serology IgG against H pylori
13c/14c urea breath test
Stool antigen test - ELISA
Endoscopy and biopsy
Rapid slide urease test (CLO)
(PEOPLE UNDER 55 DONT NECESSARY GET ENDOSCOPY)
```
51
What needs to be stopped for 2 weeks for the stool antigen test to work?
PPI
52
Eradication therapy for H pylori
Triple therapy for 7 days
- clarithromycin 500mg bd
- Amoxicillin 1g bd (or metronidazole 400mg bd)
- PPI e.g. omeprazole 20mg bd
53
Eradication therapy for H pylori is effective in what % of cases?
90%
54
What are the main reasons for failure of eradication for H pylori?
Resistance to antibiotics
| Poor compliance
55
S/Es of Eradication H pylori therapy
GI upset
56
What can be used in triple therapy for H pylori eradication if penicillin allergy?
Tetracycline
57
Surgery if have proximal gastric tumour
Usually have to take out the whole stomach
58
What is a Roux en Y surgery?
Disconnect bowel and connect oesophagus, but leave bowel next to pancreas. Forms a Y shape
59
If you have no stomach, what is an important condition you get?
Vit B12 deficiency
60
Treatment of reflux
Conservative
PPIs
Surgery
61
What do patients with paraoesophageal reflux tend to do?
Vomit
62
What can a hiatus hernia predispose you to?
Reflux
63
What % of acid going up during the day is classed as pathological?
> 4%
64
Why is a S/E of reflux surgery diarrhoea?
If damage to the vagus nerve or change in bacterial growth of the stomach
65
What test is carried out to check if H pylori eradication therapy has worked?
Urea breath test
66
What kind of drugs are a major risk factor for duodenal ulcers?
SSRIs
67
What weight loss is diagnostic of malnutrition?
Loss of 10kg in the last 6 months
