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Year 2 GI (JK) > Helicobacter Pylori and gastric disease > Flashcards

Helicobacter Pylori and gastric disease Flashcards

1
Q

What does dyspepsia mean?

A

A group of symptoms, literally meaning bad digestion

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2
Q

What are some of the symptoms associated with dyspepsia?

A 
retrosternal pain
nausea
heartburn
early satiety
pain or discomfort in the upper abdomen
vomiting
bloating
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3
Q

What is the difference between organic and functional diseases?

A

organic - specific underlying pathology

functional - no structural difference just not functioning properly

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4
Q

What are some upper GI causes of dyspepsia?

A

peptic ulcer
gastritis
non ulcer dyspepsia
gastric cancer

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5
Q

What are some lower GI causes of dyspepsia?

A

colon cancer

IBS

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6
Q

What are some other causes of dyspepsia?

A

metabolic or cardiac causes

gallstones, coeliac disease, drugs and psychological

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7
Q

What are ALARM symptoms used to decide?

A

Whether to send for an endoscopy

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8
Q

What are the ALARMS symptoms?

A 
Anorexia
Loss of weight
Anaemia
Recent onset >55 years or persistent despite treatment
Maleana/haematemesis or Mass
Swallowing problems -dysphagia
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9
Q

What is maleana?

A

sticky, dark faeces containing partly digested blood

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10
Q

What is haematemesis?

A

vomiting up blood

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11
Q

Is upper GI endoscopy therapeutic or diagnostic?

A

can be both

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12
Q

Explain the prepping done before an UGIE

A

fasted before and consented

throat spray for local anaesthetic or sedation

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13
Q

What are the risks of an UGIE?

A

perforation, bleeding or drug reaction

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14
Q

What is a perforation of the GI tract?

A

Hole in the stomach lining

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15
Q

What are the 3 main things to do if a patient presents with dyspepsia?

A

bloods
drug history
lifestyle

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16
Q

What bloods would you do in a patient presenting with dyspepsia?

A

FBC, LFT, U+Es, Ca2+, glucose, coeliac screening, serology, IgA

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17
Q

What drugs can be associated with dyspepsia?

A

NSAIDS, steroids

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18
Q

What are important lifestyle factors to consider with dyspepsia?

A

smoking, alcohol, exercise, diet, weight

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19
Q

If there are no ALARM symptoms what would you do?

A

under 55 - screen for H pylori and if positive eradicate with antibiotics and antacid,
over 55 - UGIE

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20
Q

Describe H pylori

A

spiral shaped gram negative bacteria

flagellated and microaerophilic

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21
Q

What percentage of the population does H pylori affect and when is it acquired?

A

50% - childhood

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22
Q

Where does H pylori colonise and what is the effect of this?

A

colonise the mucosa and initiate an immune response

23
Q

What are the 3 outcomes of H pylori infection?

A

asymptomatic or chronic gastritis
ulcer/metaplasia
cancer

24
Q

What is the outcome of H pylori infection dependent on?

A

site of colonisation
bacteria character
host factors - genetic and environmental

25
Q

Infection of what part of the stomach by H pylori is more likely to result in cancer? Why?

A

Nearer the top as decreases acid production and leads to atrophy

26
Q

What are the non invasive ways to diagnose H pylori infection?

A

serology
13C/14C urea breath test
stool antigen - ELISA

27
Q

What must happen 2 weeks before a stool antigen test for H pylori?

A

taken off PPI

28
Q

What are the invasive diagnostic procedures for H pylori infections?

A

endoscopy and biopsy

rapid slide urease test

29
Q

What is gastritis?

A

The inflammation in the gastric mucosa and clinical features can be seen at endoscopy

30
Q

What are the 3 types of gastritis and what is the cause of each?

A

autoimmune - proteins against parietal cells
bacterial - H pylori
chemical - bile/NSAIDS

31
Q

Who is most likely to have a peptic ulcer?

A

men - elderly

32
Q

What are some causes of peptic ulcers?

A

previous H pylori infection, smoking and NSAIDS

33
Q

What are the symptoms of peptic ulcers?

A

epigastric pain
nausea, vomit, weight loss
Nocturnal/hunger/back pain
haematemesis, melaena

34
Q

What are the treatment methods for peptic ulcers?

A

treat H pylori infection
stop NSAIDS
surgery if complicated
PPI or H2R antagonist

35
Q

What is the treatment plan for H pylori?

A

triple therapy for 7 days
2 antibiotics - clarithromycin & amoxicillin/tetracycline
PPI - omeprazole

36
Q

What are some complications of H pylori infection?

A

bleeding, perforation, fibrosis, gastric outlet obstruction

37
Q

What is the vomit like in GOO?

A

lack bile and fermented

38
Q

What happens to the electrolytes in GOO?

A

dehydrated and loss of Na/K/Cl in vomit

39
Q

What is the investigation and treatments for GOO?

A

endoscopy and aspiration of contents

balloon dilation/surgery

40
Q

What are some symptoms of gastric cancer?

A

nausea, vomit, anorexia, weight loss, GI bleed, dyspepsia, iron deficiency anaemia, GOO

41
Q

What is the aetiology of gastric cancer?

A

smoking, diet, genes, H pylori previous infection

42
Q

What are the 3 categories of gastric cancer?

A

sporadic
familial
heritable (<1%)

43
Q

How is gastric cancer histologically diagnosed?

A

endoscopy and biopsy

44
Q

How is gastric cancer staged?

A

CT

45
Q

How is gastric cancer managed after staging?

A

MDT discussion

chemotherapy/surgery

46
Q

What structures comprise the upper GI tract?

A

The oesophagus and stomach

47
Q

What structures comprise the lower GI tract?

A

small intestine

Large intestine

48
Q

List some functions of the stomach

A

Food storage
Initial digestion
Acidic environment
Intrinsic factor

49
Q

Does H pylori penetrate the epithelial layer?

A

No

50
Q

What does chronic H.pylori in the antrum lead to?

A

increase in acid production
Low risk of gastric cancer
Increased risk of ulcers

51
Q

Are duodenal or gastric ulcers more common?

A

duodenal

52
Q

Rarer causes of peptic ulcers

A

Zollinger-Ellison syndrome
hyperparathyroidism
Crohn’s disease

53
Q

Why may eradication of H.pylori infection fail?

A

resistance to antibiotics

Poor concordance

Year 2 GI (JK) (39 decks)

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