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Gastrointestinal Pathology > H Pylori and Gastric Disease > Flashcards

H Pylori and Gastric Disease Flashcards

1
Q

Definition of dyspepsia

A

Pain or discomfort in the upper abdomen

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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
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3
Q

What % of people get dyspepsia?

A

80%

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4
Q

Two types of causes of dyspepsia

A

Organic

Functional

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5
Q

Definition of organic

A

There is a specific pathology driving the symptoms

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6
Q

Definition of functional

A

Structurally things are okay but its functioning / the perception isn’t functioning as good

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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
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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
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9
Q

Definition of melena

A

Black sticky stool (blood)

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10
Q

Definition of haematemesis

A

The vomiting of blood

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11
Q

What do melena and haematemesis both indicate?

A

Upper GI blood loss

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12
Q

Complications of upper GI endoscopy and how often do these occur?

A

Perforation
Bleeding
Reaction to drug
1:2000

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13
Q

Where does upper GI endoscopy visualise?

A

Oesophagus down to the second part of duodenum

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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
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15
Q

What drugs can be related to dyspepsia?

A 
NSAIDs
Steriods
Biphosphonates
Ca antagonists
Nitrates
Theophyllines
OTT
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16
Q

What is gastritis?

A

Inflammation of the gastric mucosa

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17
Q

What therapy is done is H pylori +ve?

A

Eradication therapy

Symptomatic treatment

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18
Q

Two types of peptic ulcers

A

Gastric ulcer

Duodenal ulcer

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19
Q

What are the majority of peptic ulcers caused by?

A

H pylori

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20
Q

Causes of peptic ulcers

A 
H pylori 
Smoking
NSAIDs
Zollinger-Ellison syndrome
Hyperparathyroidism 
Crohn's disease
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21
Q

Which gender gets peptic ulcers more?

A

M > W

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22
Q

Which type of ulcer is more common?

A

DU > GU

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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
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24
Q

If a peptic ulcer bleeds, what symptom may the patient present with?

A

Haematemsesis and or melena or anaemia

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25
Q

How do antacids work?

A

Reduce the acid and this stops the acid irritating the denuded area and allows the mucosal layer to heal in ulcers

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26
Q

Why would especially older patients need an endoscopy if have an ulcer?

A

Ulcers can have cancer cells

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27
Q

Treatment of peptic ulcers

A 
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
Q

What does PPI stand for?

A

Proton pump inhibitors

29
Q

Complications of peptic ulcers

A

Acute bleeding - melena and haematemesis
Chronic bleeding - iron deficiency anaemia
Perforation
Fibrotic stricture/narrowing
Gastric outlet obstruction (oedema or stricture)

30
Q

Why would a stricture form after a peptic ulcer?

A

Ulcer heals with scar tissue which causes narrowing in the lumen which then leads to obstruction

31
Q

Presentation of gastric outlet obstruction

A 
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
Q

Diagnosis of gastric outlet obstruction

A

Endoscopy - UGIE

33
Q

Treatment of gastric outlet obstruction

A

Endoscopic balloon dilatation

Surgery

34
Q

Prognosis of gastric cancer

A

5 year survival < 20%

35
Q

Types of gastric tumours

A

Adenocarcinoma
MALT
GIST

36
Q

Most common type of gastric cancer

A

Adenocarcinoma

37
Q

Presentation of gastric cancer

A 
Dyspepsia
Early satiety
Nausea and vomiting
GI bleeding
Weight loss
Iron deficiency anaemia 
Gastric outlet obstruction
38
Q

Risk factors for gastric cancer

A 
Molecular aspects
Smoking
High salt diet / foods high in nitrates
FH
Previous gastric resection 
Biliary reflux 
Premalignant gastric pathology 
H pylori infection
39
Q

What % of gastric cancers are inherited?

A

< 15% familial clustering

1 - 3% heritable gastric cancer syndrome (HDGC, AD, CHD-1 gene)

40
Q

Investigations for gastric cancer

A

Endoscopy
Biopsy
Staging imaging investigations (CT)

41
Q

Treatment for gastric cancer

A

Surgery

Chemotherapy

42
Q

What does H pylori look like?

A

Spiral shaped
Microaeorphillic
Flagellated

43
Q

When do most people acquire H pylori?

A

Childhood

44
Q

Where is the only place H pylori can colonise? Where here does it reside? Does it penetrate the epithelial layer?

A

Gastric type mucosa
Surface mucus layer
No

45
Q

What does H pylori promote?

A

Immune response in lining of the GI tract

46
Q

Outcome of H pylori infection depends on…..

A

Size of colonisation
Characteristics of bacteria
Host factors e.g. genetics
Environmental factors e.g. smoking

47
Q

Possible outcomes of H pylori infections

A

Nothing
Gastritis
Ulcers
Role in gastric cancer

48
Q

What are you more likely to develop in the antrum of the stomach due to H pylori and why?

A

Ulcer

As acid is increased

49
Q

What are you more likely to develop in the corpus/body of the stomach due to H pylori infection and why?

A

Gastric cancer

Less acid and so changes the cells

50
Q

Investigations for H pylori infection

A 
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
Q

What needs to be stopped for 2 weeks for the stool antigen test to work?

A

PPI

52
Q

Eradication therapy for H pylori

A

Triple therapy for 7 days

  • clarithromycin 500mg bd
  • Amoxicillin 1g bd (or metronidazole 400mg bd)
  • PPI e.g. omeprazole 20mg bd
53
Q

Eradication therapy for H pylori is effective in what % of cases?

A

90%

54
Q

What are the main reasons for failure of eradication for H pylori?

A

Resistance to antibiotics

Poor compliance

55
Q

S/Es of Eradication H pylori therapy

A

GI upset

56
Q

What can be used in triple therapy for H pylori eradication if penicillin allergy?

A

Tetracycline

57
Q

Surgery if have proximal gastric tumour

A

Usually have to take out the whole stomach

58
Q

What is a Roux en Y surgery?

A

Disconnect bowel and connect oesophagus, but leave bowel next to pancreas. Forms a Y shape

59
Q

If you have no stomach, what is an important condition you get?

A

Vit B12 deficiency

60
Q

Treatment of reflux

A

Conservative
PPIs
Surgery

61
Q

What do patients with paraoesophageal reflux tend to do?

A

Vomit

62
Q

What can a hiatus hernia predispose you to?

A

Reflux

63
Q

What % of acid going up during the day is classed as pathological?

A

> 4%

64
Q

Why is a S/E of reflux surgery diarrhoea?

A

If damage to the vagus nerve or change in bacterial growth of the stomach

65
Q

What test is carried out to check if H pylori eradication therapy has worked?

A

Urea breath test

66
Q

What kind of drugs are a major risk factor for duodenal ulcers?

A

SSRIs

67
Q

What weight loss is diagnostic of malnutrition?

A

Loss of 10kg in the last 6 months

Gastrointestinal Pathology (26 decks)

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