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Helicobacter pylori and Gastric Disease Flashcards

1
Q

Upper GI Tract

A

Oesophagus
Stomach

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2
Q

Lower GI Tract

A

Small intestine
Large intestine

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3
Q

dyspepsia symptoms

A

Epigastric pain
Burning
Fullness
Bloating
Satiety
Nausea
Sickness
Heartburn
Reflux
Discomfort

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4
Q

Dyspepsia greek meaning

A

dys = bad, pepsis = digestion

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5
Q

what are the collective group of symptoms for dyspepsia

A

Pain or discomfort in the upper abdomen

upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn

For 4 weeks ( 12weeks Rome criteria)

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6
Q

is dyspepsia common

A

80 % of people, most have no serious underlying disease

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7
Q

GP consultations percentage for dyspepsia patients

A

When broadly defined, dyspepsia occurs in 40%, leads to GP consultation in 5% and referral for endoscopy in 1% of the population annually.

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8
Q

what can cause symptoms of dyspepsia for upper GI

A

GORD
Peptic ulcer
Gastritis
Non ulcer dyspepsia
Gastric cancer

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9
Q

What can cause the symptom of dyspepsia in lower GI

A

Gallstones
Pancreatic disease
IBS
Colonic cancer
Coeliac disease

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10
Q

what may be other causes of dyspepsia

A

Other systemic disease – metabolic, cardiac

Drugs

Psychological

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11
Q

what do you do if a patient presents with dyspepsia

A

History & examination are key!!

Drug history – NSAIDs, steroids, bisphosphonates, Ca antagonists, nitrates, theophyllines, remember OTT

Lifestyle – alcohol, diet, smoking, exercise, weight reduction

Examination including BMI

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

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12
Q

what bloods need to be done for dyspepsia

A

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

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13
Q

when do you refer for endoscopy

A

ALARMS

Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia

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14
Q

what is an upper GI endoscopy

A

Diagnostic and therapeutic upper GI endoscopy

Local anaesthetic (throat spray) or sedation

Day case

Fasted

Consent

Risks - 1:2000 risk perforation, bleeding, reaction to drugs given

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15
Q

what is helicobacter pylori

A

Gram negative, spiral-shaped, microaerophilic, flagellated Gram –ve bacteria

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16
Q

how common is helicobacter pylori

A

Infects 50% world population

Acquired in childhood

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17
Q

what can H.pylori only colonise

A

only colonise gastric type mucosa

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18
Q

where does H.pylori reside

A

in the surface mucous layer and does not penetrate the epithelial layer

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19
Q

what does an H.pylori infection do

A

Evokes immune response in underlying mucosa – dependent on host genetic factors

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20
Q

what is the infection pathway and pathogenesis for Helicobacteria

A
  • enters host and aurvives
  • motility and chemotaxis
  • adhesin receptor interaction (establish colony)
  • toxin release and damage to host
  • intracellular replication
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21
Q

what is the clinical outcome of helicobacter pylori for >80%

A

asymptomatic or chronic gastritis

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22
Q

what is the C

A

chronic atrophic gastritis
intestinal metaplasia
gastric or duodenal ulcer

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23
Q

what is the the clinical outcome of helicobacter pylori for 1%

A

gastric cancer
MALT lymphoma

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24
Q

what is the clinical outcome of H.Pylori dependent on

A

site of colonization

characteristics of bacteria

host factors e.g. genetic susceptibility

environmental factors e.g. smoking

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25
what are the three different types of gastritis caused by chronic H.Pylori infection
Antral predominant Gastritis Mild Mixed Gastritis Corpus predominant Gastritis
26
what does Corpus predominant Gastritis mainly affect
the body of the stomach
27
Corpus predominant Gastritis effect on acid secretion
decreased acid secretion and Gastric Atrophy
28
what condition will Corpus predominant Gastritis lead to
gastric cancer
29
what part of the stomach is predominantly affected by Antral predominant Gastritis
antrum
30
what effect does Antral predominant Gastritis have on acid secretion
increased acid secretion low Risk of Gastric Ca
31
what condition will Antral predominant gastritis lead to
Duodenal ulcer
32
Mild Mixed Gastritis
Normal Acid producing No significant disease
33
what are the non invasive diagnostic methods of H.Pylori
Serology: IgG against H. pylori 13C /14C Urea Breath Test Stool antigen test – ELISA - need to be off PPI for 2 weeks
34
what are the invasive methods for H.Pylori
requires endoscopy Histology: gastric biopsies stained for the bacteria Culture of gastric biopsies Rapid slide urease test (CLO)
35
Rapid slide urease test (CLO)
A biopsy is taken from the stomach and is put into the well where the gel is impregnated with urea if there is bacteria in the specimin the ureas reacts with the urea and forms ammonia changing the ph of the well and the colour to pink (positive) yellow (negative)
36
what colour will a positive Rapid slide urease test (CLO) show
Pink
37
what colour will a negative Rapid slide urease test (CLO) show
Yellow
38
what is gastritis
Inflammation in the gastric mucosa Histological diagnosis Clinical features seen at endoscopy
39
what are the causes of Gastritis
Autoimmune (parietal cells) Bacterial (H. pylori) Chemical (bile/NSAIDs)
40
what age groups are most commonly affected by peptic ulcers
Both GU and DU commoner in elderly people
41
what are the majority of peptic ulcers caused by
Helicobacter pylori infection (50% GU 80% DU)
42
what are peptic ulcers also caused by
NSAIDs, smoking Rarely they are caused by other conditions such as Zollinger-Ellison syndrome, hyperparathyroidism, Crohn’s disease
43
what symptoms are associated with peptic ulcer
pigastric pain is the main feature (pointing sign, may be relieved by antacids) Nocturnal/hunger pain (more common in DU) Back pain (may suggest penetration of a posterior DU) Nausea and occasionally vomiting Weight loss and anorexia (chronic ulcer) Only sign may be epigastric tenderness If the ulcer bleeds, patients may present with haematemesis and/or melaena, or anaemia
44
If the peptic ulcer bleeds what will the patient present with
haematemesis and/or melaena, or anaemia
45
how do you treat a peptic ulcer caused by H.Pylori
Ulcers caused by H. pylori are treated by eradication therapy to get rid of the bacteria Complications are treated as they arise
46
what are pharmalogical treatments for peptic ulcers
Antacid medication – proton pump inhibitors (omeprazole)or H2 receptor antagonists (ranitidine) If NSAIDs are also involved, these have to be stopped if possible, or should continue to receive other protective agents following eradication therapy
47
when is surgery indicated for a peptic ulcer
In a complicated PUD
48
How do you eradicate H.Pylori
Triple therapy for 7 days Clarithromycin 500mg bd Amoxycillin 1g bd (or Metronidazole 400mg bd) Tetracycline is given if penicillin allergy PPI: e.g. omeprazole 20mg bd
49
is eradication of H.pylori effective
In 90% of cases
50
what are the complications of a peptic ulcer
Acute bleeding – melaena and haematemesis Chronic bleeding – iron deficiency anaemia Perforation Fibrotic stricture (narrowing) Gastric outlet obstruction – oedema or stricture
51
gastric outlet obstruction symptoms
Vomiting – lacks bile, fermented foodstuffs Early satiety, abdominal distension, weight loss, gastric splash Dehydration and loss of H+ and Cl- in vomit Metabolic alkalosis
52
blood results for gastric outlet obstruction
low Cl, low Na, low K, renal impairment
53
diagnosis for gastric outlet obstruction
UGIE (prolonged fast/aspiration of gastric contents), identify cause – stricture, ulcer, cancer
54
how do you treat gastric outlet obstruction
endoscopic balloon dilatation, surgery
55
Gastric cancer
Second commonest malignancy worldwide Large geographical variation – genetic and environmental factors Very poor prognosis (5 yr survival <20%) Presents late in Western countries Majority are adenocarcinomas (epithelial cells)
56
what are types of gastric tumours
MALT, GIST
57
how do patients present with gastric cancer
Dyspepsia, early satiety, nausea & vomiting, weight loss, GI bleeding, iron deficiency anaemia, gastric outlet obstruction
58
Aetiology of gastric cancer
Smoking has a definite positive association as has some food groups e.g. high salt diet, foods high in nitrates. The major aetiological factor in GC is HP. Other factors to consider – family history, previous gastric resection, biliary reflux, premalignant gastric pathology
59
characteristics of majority of gastric cancer
sporadic with no demonstrable inherited component
60
characteristics of <15% of gastric cancer
familial clustering, most not associated with definitive germline mutation
61
characteristics of 1-3% of gastric cancer
heritable gastric cancer syndromes HDGC;AD, CDH-1 gene (E-cadherin)
62
how do you make a histological diagnosis of gastric cancer
Endoscopy and biopsies
63
what investigations are done for gastric cancer
Staging investigations – has it spread elsewhere? CT chest/abdo – lymph nodes and liver/lungs/peritoneum/bone marrow MDT discussion – imaging/histology/patient fitness
64
MDT discussion for gastric cancer
imaging/histology/patient fitness Who is present? gastroenterologist, pathologist, radiologist, upper GI surgeons, oncologists, specialist nurses
65
treatment of gastric cancer
surgical and chemotherapy

Alimentary System (44 decks)

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