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GI > H. Pylori and Gastric Disease > Flashcards

H. Pylori and Gastric Disease Flashcards

1
Q

What is dyspepsia?

A

Indigestion

Pain or discomfort in the upper abdomen (epigastric) - very wide variety of symptoms (burning, nausea, pain etc.)

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2
Q

What are some upper GI derived causes of dyspepsia?

A

GORD
Peptic ulcer
Gastritis
Gastric cancer

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3
Q

Non upper GI causes of dyspepsia?

A

Pancreatic disease
Gallstones
Coeliac disease
Drugs

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4
Q

What are important investigations/history questions for when a patient presents with dyspepsia?

A

Drug history (NSAIDs/theophyllines/steroids)

Bloods (FBC, ferritin, LFTs, U&E’s)

Lifestyle (diet/alcohol)

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5
Q

When should you refer a patient with dyspepsia for an endoscopy?

A 
When they present with ALARMS symptoms
A - anorexia
L - loss of weight 
A - anaemia 
R - recent onset of progressive symptoms 
M - Melaena/haematemesis or mass 
S - swallowing problems/dysphagia
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6
Q

What type of gram stain bacteria is helicobacter pylori?

A

Gram negative

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7
Q

Where does H. pylori reside in an infected human host?

A

Can only colonize gastric type mucosa
Resides in the surface mucous layer, doesn’t penetrate epithelium
Causes immune response in the underlying mucosa depending on the host genetics

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8
Q

Possible outcomes of H. pylori infection?

A

Asymptomatic/chronic gastritis (80%)

Atrophic gastritis/ulcers in stomach or duodenum (15-20%)

Gastric cancer (<1%)

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9
Q

How does antral predominant gastritis differ from corpus (body) predominant gastritis in progression?

A

Antral gastritis - increase acid in response to infection, lower risk of cancer but higher for other disease

Corpus gastritis - decrease acid, atrophy of gastric cells. Higher cancer risk

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10
Q

Non-invasive methods of diagnosing H. Pylori infection?

A

Serology (IgG)

Urea breath test

Stool antigen test (ELISA)

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11
Q

Invasive methods for H. Pylori diagnosis?

A

Histology of biopsies
Culture of biopsies
Rapid slide urease test (CLO)

All require endoscopy for biopsy/tissue sampling

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12
Q

3 Types of gastritis?

A

A - autoimmune
B - bacterial (H. pylori)
C - Chemical (NSAIDs)

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13
Q

Causes of peptic ulcers?

A

H. Pylori infection (majority)
NSAIDs
Smoking

Rare: Crohn’s, Zollinger-Ellison syndrome, hyperparathyroidism

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14
Q

Are peptic ulcers more common in the duodenum or gastric region?

A

Duodenum

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15
Q

Symptoms of peptic ulcers?

A
  • Epigastric pain (may be relieved by antacids)
  • Nocturnal hunger/pain
  • Haematamesis/malaena/anaemia
  • Back pain
  • Nausea/vomiting
  • Weight Loss
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16
Q

What is malaena?

A

Blood in faeces

dark sticky complexion

17
Q

Treatment of peptic ulcers?

A

Antibiotics to get rid of H. Pylori if bac infection

Antacid medication:
Proton pump inhibitors/H2 receptor agonists

Stop NSAIDs if they’re being used, surgery only in complicated cases

18
Q

Drug cycle for eradication of H. Pylori infection?

A

Triple therapy for 7 days:

  • PPI (omeprazole)
  • Amoxycillin (or metrondiazole)
  • Clarithromycin

Effective for 90% of cases

19
Q

Possible complications of peptic ulcers?

A 
Acute bleeding (haematemesis/malaena)
Chronic bleeding (anaemia)
Perforation 
Obstruction (stricture by fibrosis/oedema)
20
Q

If a mass develops or excessive stricture from fibrosis occurs at the gastric outlet, what can happen? Symptoms?

A 
The gastric outlet can become obstructed
Symptoms:
- vomiting (lacks bile)
- Early satiety, weight loss
- Abdominal distension
21
Q

Investigations for gastric outlet obstruction?

A

Bloods (metabolic alkalosis, low Cl, Low Na, Low K)

UGIE (upper GI endoscopy)

22
Q

Treatment of gastric outlet obstruction?

A

Fast and aspirate gastric contents
Identify what is causing the obstruction
Endoscopic balloon dilatation / surgery

23
Q

What percentage of the population have experienced H. Pylori infection?

A

50%

24
Q

Is gastric cancer usually heritable?

A

No, mostly not inherited

Mutations in HDGC and CDH-1 genes can cause heritable gastric cancer though (1-3%)

25
Q

Which genes can act as biomarkers for gastric cancer?

A

HDGC

CDH-1

GI (46 decks)

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