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Y1 - Gatrointestinal > H. Pylori Infection > Flashcards

H. Pylori Infection Flashcards

1
Q

Describe helicobacter pylori.

A 
Slow-growing
Spiral
Gram-negative
Flagellate
Urease producing
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2
Q

The majority of people infected with H. pylori are symptomatic
True/false

A

False

Majority are asymptomatic

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3
Q

How does H. pylori adhere to the epithelial surface?

A

Using adherence molecules such as BabA, which binds to the lewis antigen on the surface of gastric mucosal cells

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4
Q

How does H. pylori cause damage to epithelial cells?

A

The release of enzymes and induction of apoptosis through binding to class II MHC molecules

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5
Q

What are the results of H. pylori infection?

A

Inflammation (gastritis and gastric intestinal metaplasia)
Peptic ulcers
Gastric cancer

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6
Q

What is the usual effect of H. pylori?

A

Antral gastritis

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7
Q

What are the symptoms of antral gastritis?

A

Usually asymptomatic
Slight dyspepsia
When chronic, causes hypergastrinaemia, this increase in acid output can led to duodenal ulceration

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8
Q

What type of gastritis are gastric ulcers associated with?

A

Gastritis affecting the body and antrum, causing parietal cell loss and reduction in acid production

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9
Q

What is a peptic ulcer?

A

A break in the superficial epithelial cells penetrating to the muscularis mucosae
Has a fibrous base and increase in inflammatory cells

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10
Q

What is an erosion in peptic ulcer disease?

A

A superficial break in the mucosa alone

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11
Q

Which are more common, duodenal or gastric ulcers?

A

Duodenal

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12
Q

Which areas are gastric and duodenal ulcers most commonly found?

A

Gastric: lesser curvature of the stomach
Duodenal: duodenal cap, with inflamed, haemorrhage or friable surrounding mucosa

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13
Q

What are the symptoms of peptic ulcer disease?

A

Epigastric pain (recurrent, burning, highly localised)
May be relieved at night
Nausea may accompany pain
Vomiting may relieve pain
Anorexia and weight loss (particularly GUs)
Epigastric tenderness

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14
Q

In which contexts is diagnosis done for H. pylori infection?

A

Active PU disease
Previous PU disease
Mucosal-associated lymphoid tissue (MALT) lymphoma
To test and treat patients under 55 without alarm symptoms

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15
Q

What are the methods of investigation for H. pylori?

A 
Serological tests
13C-urea breath test
Stool antigen test
Biopsy urease test
Histology
Culture
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16
Q

Which antibodies do serological tests detect for H. pylori?

A

IgG antibodies

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17
Q

When are serological tests helpful and unhelpful?

A

Helpful for diagnosis

Unhelpful for confirming eradication as IgGs take a long time to decline

18
Q

When is a 13C-urea breath test helpful and unhelpful?

A

Helpful for screening

Less helpful when patient has taken antibiotics in the past 4 weeks or PPIs in the past 2 weeks

19
Q

When is a stool antigen test helpful and unhelpful?

A

Used to determine H. pylori status and to monitor efficacy of eradication therapy
Less helpful if patient has taken PPIs in the past 2 weeks

20
Q

What is investigation method is used in patients with refractory H. pylori to identify the appropriate antibiotic regimen?

A

Culture

21
Q

What is the management when H. pylori is detected?

A

Eradication therapy

22
Q

What are the regimens for H. pylori eradication?

A

Omeprazole 20mg + clarithromycin 500mg + amoxicillin 1g, all twice daily for 7-14 days
Omeprazole 20mg + metronidazole 400mg + clarithromycin 500mg, all twice daily for 7-14 days

23
Q

What regimen is used for H. pylori eradication in eradication failure or areas of clarithromycin resistance?

A 
Bismuth chelate 120mg x4 daily
Metronidazole 400mg x3 daily
Tetracycline 500mg x4 daily
A PPI 20-40mg x2 daily
All for 14 days
24
Q

What are the complications of peptic ulcer disease?

A

Haemorrhage
Perforation
Gastric outlet obstruction

25
Q

Which ulcers perforate more often, gastric or duodenal?

A

Duodenal

26
Q

What surgery is usually done for an ulcer that has perforated?

A

Laparoscopic surgery to close the perforation and drain the abdomen

27
Q

What conservative management is done for the elderly and very sick with a perforated ulcer?

A

Nasogastric suction
IV fluids
Antibiotics

28
Q

What are the causes of gastric outlet obstruction due to a peptic ulcer?

A

Active ulcer with surrounding oedema

Healing of an ulcer has produced scarring

29
Q

What is the main symptom of gastric outlet obstruction, and why is this caused?

A

Vomiting

Stomach becomes full of gastric juice and ingested food, causing vomiting

30
Q

What are the characteristics of vomiting produced by gastric outlet obstruction?

A 
Without pain
Infrequent
Projectile
Large in volume
O/E there may be a succession splash
Severe vomiting causes loss of acid from stomach and hypokalaemic metabolic alkalosis
31
Q

How is diagnosis made for gastric outlet obstruction?

A

Endoscopy

32
Q

What is the management for the vomiting caused by gastric outlet obstruction?

A

IV fluids and electrolyte replacement
Gastric drainage with nasogastric tube
Potent acid suppression
Endoscopic dilation of the pyloric sphincter or luminal stenting

33
Q

What should be done if an ulcer is recurrent?

A

Check for H. pylori
Rule out Zollinger-Ellison syndrome
Exclude malignancy

34
Q

What is ‘dumping’?

A

A number of abdominal symptoms (nausea and distension associated with sweating, faintness and palpitations) that are due to ‘dumping’ of fluid contents into the jejunum, causing rapid fluid shifts

35
Q

What are the possible long term complications of surgical treatment?

A

Recurrent ulcer
Dumping
Diarrhoea
Nutritional complications

36
Q

What are the possible nutritional complications that can result after gastric surgery?

A

Iron deficiency - due to poor absorption
Folate deficiency - due to poor intake
Vitamin B12 deficiency - due to intrinsic factor deficiency
Weight loss - due to reduced intake

37
Q

What are some H. pylori associated diseases?

A

Gastric adenocarcinoma

Gastric B-cell lymphoma

38
Q

What can long-term use of aspirin and other NSAIDs lead to?

A

Mucosal damage and ulceration

39
Q

What is the management for NSAID-induced ulceration?

A

Stop NSAIDs
Give PPIs
Start eradication therapy if H. pylori positive

40
Q

What is the management for NSAID-induced ulceration if stopping NSAIDs is not possible?

A

Use an NSAID with less GI side-effects at the lowest dose possible
If there is no CVD risk a COX-2 inhibitor can be used
Prophylactic cytoprotective therapy e.g. PPI or misoprosol

Y1 - Gatrointestinal (31 decks)

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