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*GI System - Pathology > H. Pylori + Gastric Disease > Flashcards

H. Pylori + Gastric Disease Flashcards

1
Q

What are the functions of the stomach?

A 
Storage 
Start digestion 
Acid secretion 
Secretion of intrinsic factor
Secretion of enzymes (e.g. pepsin)
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2
Q

What is dyspepsia?

A

General term to describe a group of symptoms causing pain/discomfort in upper abdomen

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3
Q

Describe the 9 symptoms than can be included in dyspepsia

A
  • pain/discomfort in upper abdomen
  • retrosternal pain
  • anorexia
  • nausea
  • vomiting
  • bloating
  • fullness
  • early satiety
  • heartburn
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4
Q

What percentage of people have dyspepsia?

A

80%; majority with no underlying disease

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5
Q

What medical professionals generally treats dyspepsia symptoms?

A

GP; community pharmacist

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6
Q

What are 4 upper GI causes of dyspepsia?

A

Peptic ulcer, gastritis, non-ulcer dyspepsia, gastric cancer

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7
Q

Name 3 other organ related cause of dyspepsia?

A

Hepatic causes
Gallstones
Pancreatic disease

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8
Q

Name 2 lower GI causes of dyspepsia?

A

IBS, colonic cancer

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9
Q

Name 3 other causes of dyspepsia

A

Coeliac, psychological, drugs

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10
Q

What types of systemic disease cause dyspepsia?

A

Metabolic (high Ca; diabetes)

Cardiac (retrosternal heaviness - IHD)

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11
Q

What is the acronym for red flag symptoms for when to refer for endoscopy?

A

Anorexia
Loss of weight
Anaemia - iron deficiency (could be lesion bleeding in upper GI)
Recent onset > 55 years or persistent despite treatment (could be cancer)
Melaena/haematemesis
Swallowing problems/dysphagia

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12
Q

What are the conditions of an upper GI endoscopy?

A

local anaesthetic/sedation, day case, fasted, consent

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13
Q

What are the risks of an upper GI endoscopy?

A

1:2000 perforation, bleeding, reaction to drugs given

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14
Q

What are the 4 elements of investigations into someone with dyspepsia?

A

History + examination
Bloods
Drug history
Lifestyle

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15
Q

What bloods might you request for someone with dyspepsia?

A

FBC, ferritin, LFTs, U+Es, calcium, glucose, coeliac serology/serum IgA

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16
Q

What drugs should be asked about in drug history of someone with dyspepsia?

A

NSAID (brufen, nurofen, ibruprofen, naproxen)
Steroids
Bisphosphonates (osteoporosis - large tablet)
Ca antagonists
Nitrates
Theophyllines
remember OTC

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17
Q

What aspect of lifestyle should be explored?

A

Alcohol, diet, smoking, exercise, weight reduction

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18
Q

What type of bacteria is H. pylori?

A

gram neg, microaerophillic, flagellated

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19
Q

Where can H. pylori only colonise?

A

Gastric type mucosa (stomach) - surface mucous layer not epithelial layer; burrows in to get away from gastric acid

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20
Q

What is H. pylori categorised as?

A

Type I carcinogen

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21
Q

What is H. pylori effect on epithelial cells?

A

Cannot go through them but has an effect on those which sit close to it

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22
Q

What is H. pylori mechanism?

A

It is urease positive - breaks down surrounding substrates and creates a halo of alkilinity

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23
Q

What are 4 clinical outcomes of H. pylori infections?

A 
Asymptomatic/chronic gastritis (>80%)
Chronic atrophic gastritis; intestinal metaplasia 
Gastric/duodenal ulcer 
(15-20%)
Gastric cancer/MALT lymphoma (<1%)
24
Q

What is the outcome of H. pylori infection dependent on?

A

Site of colonisation
Characteristics of bacteria (some more virulent)
Host factors e.g. host susceptibility and other environmental factors e.g. smoking

25
Q

What is the outcome of antral predominant gastritis from chronic H. pylori infection?

A

Increased acid, low risk of gastric carcinoma - results in DU disease (ulcer etc)

26
Q

What is the outcome of mild mixed gastritis from chronic H. pylori infection?

A

Normal acid - no significant disease

27
Q

What is the outcome of corpus predominant gastritis from chronic H. pylori infection?

A

Decreased acid, gastric atrophy - gastric carcinoma (or gastric ulcer)

28
Q

What are 3 non-invasive tests for H. pylori infection?

A

Serology: IgG against H. pylori
13C /14C urea breath test
STOOL ANTIGEN TEST - ELISA - need to be off PPI for 2 weeks

29
Q

What are 3 invasive tests for H. pylori infection?

A

Histology: gastric biopsies stained for bacteria
Culture of gastric biopsies
RAPID SLIDE UREASE TEST (CLO) - ammonia - urease present = H. pylori present = pink

30
Q

What is gastritis?

A

Inflammation in gastric mucosa

31
Q

What are the three types and their associated causes?

A

Autoimmune - parietal cells
Bacterial - H. pylori
Chemical - bile/NSAIDs

32
Q

What are the majority of peptic ulcers caused by?

A

H. pylori

33
Q

What are 2 other possible causes of peptic ulcers?

A

NSAIDs

Smoking

34
Q

Name 3 other conditions which peptic ulcers are rarely caused by?

A

Zollinger-Ellison syndrome
Hyperparathyroidism
Crohn’s

35
Q

Name 5 symptoms associated with peptic ulcers? (E, N, B, N, W)

A

Epigastric pain (main feature - may be only symptom)
Nocturnal/hunger pain (more DU)
Back pain (suggests penetration of posterior DU)
Nausea/occasionally vomiting
Weight loss + anorexia

36
Q

What may patients present with if a peptic ulcer bleeds?

A

Haematemesis and/or melaena (acute)

Anaemia (chronic)

37
Q

Investigation for peptic ulcer?

A

endoscopy

38
Q

Why are ulcers biopsied?

A

to establish they are benign

39
Q

How are peptic ulcers treated?

A

H. pylori eradication
Antacid meds (PPI or H2 receptor agonist (ranitidine))
Stop NSAID if involved
Surgery only in complicated PUD

40
Q

How to eradicate H. pylori?

A

TRIPLE THERAPY FOR 7 DAYS

Clarithromycin, amoxycillin (tetracycline in pen allergy), PPI (omeprazole)

41
Q

Why are PPI involved in H pylori triple therapy?

A

To protect stomach from excess acid production

42
Q

What is the success rate for H. pylori infection?

A

90% of cases

43
Q

5 potential complications of peptic ulcers?

A 
Acute bleeding
Chronic bleeding
Perforation 
Fibrotic stricture
Gastric outlet obstruction
44
Q

How does gastric outlet obstruction arise in peptic ulcers?

A

if pyloric sphincter is affected

45
Q

Symptoms of gastric outlet obstruction?

A

Vomiting (main symptom - lacks bile + foodstuff)
Early satiety, distension, weight loss, gastric splash
Metabolic alkalosis

46
Q

What would the bloods result be in someone with gastric outlet obstruction?

A

low Cl, low Na, low K, renal impairment

47
Q

How is gastric outlet obstruction officially diagnosed?

A

UGIE (identify cause - structure, ulcer, cancer)

48
Q

How is gastric outlet obstruction treated?

A

Endoscopic balloon dilatation, surgery

49
Q

What is the prognosis for gastric cancer?

A

5-year survival <20%

50
Q

Gastric cancer presents late in western countries, why?

A

asymptomatic initially

51
Q

What histological type are most gastric cancers?

A

Adenocarcinoma (epithelial cells)

52
Q

How does a person with gastric cancer generally present?

A 
Dyspepsia
Early satiety 
Nausea + vomit
Weight loss
GI bleeding
Anaemic
GOO
53
Q

Investigations for gastric cancer?

A

Endoscopy w biopsy

CT chest + abdo to stage

54
Q

Treatment for gastric cancer?

A

surgery

chemo

55
Q

What are aetiologies for gastric cancer?

A 
H. pylori infection 
Familial
Previous gastric resection 
Biliary reflux
Premalignant gastric pathology 
Smoking
Some food groups e.g. high salt, high nitrate

*GI System - Pathology (8 decks)

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