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The Alimentary Canal > Helicobacter Pylori and Gastric Disease > Flashcards

Helicobacter Pylori and Gastric Disease Flashcards

1
Q

What are some symptoms which can be included in dyspepsia?

A

Epigastric pain, burning, fullness, bloating, satiety, nausea, sickness, heartburn, reflux and discomfort

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2
Q

What does dyspepsia mean?

A

Bad digestion

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3
Q

What does dyspepsia describe?

A

A group of symptoms which cause pain or discomfort in upper abdomen

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4
Q

How long for symptoms to have dypepsia?

A

4 weeks

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5
Q

Is dyspepsia common?

A

Yes, very common
80% of people but most no serious underlying disease

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6
Q

What upper GI problems can cause dyspepsia?

A

GORD, peptic ulcer, gastritis, non ulcer dyspepsia and gastric cancer

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7
Q

What are some causes for dyspepsia?

A

Drugs
Gallstones
Pancreatic disease
Coeliac Disease
Psychological

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8
Q

What are some drugs to be aware of in dyspepsia?

A

NSAIDs, steroids, bisphosphonates, Ca antagonists, nitrates, theophylline

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9
Q

What bloods should be done for a patient with dyspepsia?

A

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

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10
Q

When should you refer a patient for an endoscopy?

A

Anorexia
Loss of weight
Anaemia
Recent onset if over 55 or persistence
Melaena/haematemesis
Swallowing

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11
Q

What is an upper GI endoscopy?

A

Diagnostic and therapeutic upper GI endoscopy
Under local anaesthetic or sedation
Day case and fasted

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12
Q

What are the risks of an endoscopy?

A

Perforation
Bleeding
Reaction to drugs given

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13
Q

What are the diagnostic pathways of dyspepsia?

A

Only red flags sent to endoscopy
Lifestyle advice if not and medications like Gaviscon, anti-acid meds
Think of testing for H. pylori

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14
Q

What is Helicobacter Pylori?

A

Gram negative bacteria
Spiral shaped, microaerophilic and flagellated

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15
Q

Where can H.pylori colonise?

A

Only gastric type mucosa

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16
Q

Where does H. pylori reside?

A

In the surface of mucous layer and does not penetrate the epithelial layer
Can survive in acidic environment of stomach

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17
Q

What does H. pylori evoke?

A

Immune response in underlying mucosa causing inflammation - dependant on host genetic factor

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18
Q

What enzyme does H. pylori produce?

A

Urease

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19
Q

Describe the pathogenesis of H. pylori?

A

Enters host and survival
Motility and chemotaxis
Adhesion receptor interacted and establishes colonisation
Toxins release and damage to host

20
Q

What are the clinical outcomes of Helicobacter pylori infections?

A

Mostly asymptomatic or chronic gastritis
Some get chronic atrophic gastritis, intestinal metaplasia or gastric/duodenal ulcer
Least common is gastric cancer or MALT lymphoma

21
Q

What is the outcome of H. pylori dependant on?

A

Site of colonisation
Characteristics of bacteria
Host factors - susceptibility and environmental factors

22
Q

What does chronic H. pylori infection cause to antral predominant gastritis?

A

Increased acid
Low risk of gastric cancer
DU disease

23
Q

What does chronic H. pylori infection cause to corpus predominant gastritis?

A

Decreased acid
Gastric atrophy
Risk of gastric cancer

24
Q

What are the non-invasive ways of diagnosing 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)

25
Q

What are the invasive ways of diagnosing H. pylori infection?

A

Requires endoscopy for biopsy
Histology can be stained for bacteria
Culture
Rapid slide urease test (CLO)

26
Q

Describe a CLO test

A

Campylobacter like organism
Urease acts on gel which has ammonia to turn pink - positive
Biopsy from stomach

27
Q

What is gastritis?

A

Inflammation of the gastric mucosa

28
Q

How is gastritis diagnosed?

A

Histological
Clinical features seen at endoscopy

29
Q

What are the 3 types of gastritis?

A

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

30
Q

What do peptic ulcers include?

A

Gastric and Duodenal ulcer

31
Q

What are the majority of peptic ulcers caused by?

A

Helicobacter Pylori

32
Q

What are some other causes of peptic ulcers?

A

NSAIDs and smoking
Rarely - Zollinger-Ellison syndrome, hyperparathyroidism and Crohn’s disease

33
Q

What is the main symptom of peptic ulcers?

A

Epigastric pain/ tenderness

34
Q

What are other symptoms of peptic ulcers?

A

Hunger pain, back pain, nausea, vomiting, weight loss, if ulcer bleeds then haemoptysis

35
Q

How are peptic ulcers treated when caused by H. pylori?

A

Eradication therapy to get rid of bacteria

36
Q

How are peptic ulcers treated?

A

Antacid meds - PPI (omeprazole) or H2 receptor antagonist
If NSAIDs involved then stop

37
Q

When is surgery needed in peptic ulcers?

A

Only in complicated PUD

38
Q

Describe the eradication of H. pylori infection

A

Triple therapy for 7-10 days
Effective in 90% of cases

39
Q

Describe triple therapy for eradication of H. pylori infection

A

Clarithromycin
Amoxycillin (tetracycline if penicillin allergy)
PPI - omeprazole

40
Q

What are some complications of a peptic ulcer?

A

Acute bleeding
Chronic bleeding
Perforation
Fibrotic structure
Gastric outlet obstruction

41
Q

What are the symptoms of gastric outlet obstruction?

A

Vomiting as lacks bile and fermented foodstuffs
Early satiety, weight loss, abdominal distention and gastric splash
Dehydration

42
Q

What would bloods show in gastric outlet obstruction?

A

Low Cl, low Na, low K and renal impairment

43
Q

How gastric outlet obstruction diagnosed?

A

Endoscopy

44
Q

How is gastric outlet obstruction treated?

A

Balloon dilation
Surgery

45
Q

How are most gastric cancers caused?

A

Majority are sporadic with no demonstrable inherited component
Some familial clustering but no definite germline mutation
Not many have heritable syndromes

The Alimentary Canal (33 decks)

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