H. Pylori and upper GI disease Flashcards
What is dyspepsia?
Indigestion
What is significant dyspepsia?
Dyspepsia which persists for 4 weeks or more
What are some symptoms of dyspepsia?
Epigastric pain Nausea Gastric reflux Burning Bloating Discomfort
What factors warrant use of an endoscopy?
Anaemia Loss of weight Anorexia Recent onset of progressive symptoms Malaena Swallowing problems
What are some upper GI disorders in the differential diagnosis of dyspepsia?
Peptic ulcer
Gastritis
Gastric cancer
What are some lower GI disorders in the differential diagnosis of dyspepsia?
IBS
Colonic cancer
What are some other causes of dyspepsia?
Hepatic Psych Pancreatic Coeliac Drugs Metabolic
What are some useful blood tests for dyspepsia?
FBC Ferritin U&Es Calcium Glucose Serum IgA
What drug classes may aggravate dyspepsia?
NSAIDs
Steroids
What patient habits may cause dyspepsia?
Alcohol
Smoking
Diet
Describe H. Pylori.
Gram negative baccili
Microaerophilic
Flagellated
Resides on mucosal surface
Does H Pylori penetrate the epithelium?
No
How does H Pylori manage the acidic environment?
Releases urease to make immediate environment slightly less acidic
What are some useful tests for H Pylori infection?
Serology -IgA
Urea breath test
Stool antigen test (ELISA)
Endoscopy
Biopsy
Culture
What group are peptic and duodenal ulcers more common in?
Elderly
What is Zollinger-Ellison syndrome?
Tumour formed in pancreas or duodenum and triggers massive gastrin production
Leading to excess acid production
Can cause ulcers
What are 3 principles of peptic ulcer treatment?
Eradication therapy
Acid suppression
NSAIDs must be stopped if they are in use
What are some drugs used for acid suppression?
Omeprazole
Ranitidine
What is the 7 day triple therapy used for H Pylori eradication?
Amoxycilin
Clarithromycin
Proton Pump Inhibitor (Omeprazole)
What are some complications of peptic ulcers?
Acute bleeding Chronic bleeding Perforation Fibrotic stricture Gastric outlet obstruction
What may Zollinger-Ellison syndrome cause?
Recurrent poor healing duodenal ulcers
Why do we test for serum calcium?
Hypercalcaemia can cause pancreatitis which can cause hypocalcaemia
Calcium is an indicator of pancreatitis severity
Why do we measure U&Es in dyspepsia and peptic ulcers?
They may have changed due to renal hypotension or vomiting
Also to establish a baseline before fluid resuscitation
What are we looking for on an FBC?
Signs of inflammation like raised WBC or low Hb due to bleeding
Neutrophilia would be present in pancreatitis
Why do we check glucose levels?
Hyperglycaemia indicates sever pancreatitis as it reflects pancreatic insulin production
What are some hepatic causes of dyspepsia?
Cirrhosis
AFLD
NAFLD
What are some psychiatric causes of dyspepsia?
Anxiety
Depression
