Helicobacter Pylori and gastric disease

Question 1

What does dyspepsia mean?

Answer 1

A group of symptoms, literally meaning bad digestion

Question 2

What are some of the symptoms associated with dyspepsia?

Answer 2

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

Question 3

What is the difference between organic and functional diseases?

Answer 3

organic - specific underlying pathology

functional - no structural difference just not functioning properly

Question 4

What are some upper GI causes of dyspepsia?

Answer 4

peptic ulcer
gastritis
non ulcer dyspepsia
gastric cancer

Question 5

What are some lower GI causes of dyspepsia?

Answer 5

colon cancer

IBS

Question 6

What are some other causes of dyspepsia?

Answer 6

metabolic or cardiac causes

gallstones, coeliac disease, drugs and psychological

Question 7

What are ALARM symptoms used to decide?

Answer 7

Whether to send for an endoscopy

Question 8

What are the ALARMS symptoms?

Answer 8

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

Question 9

What is maleana?

Answer 9

sticky, dark faeces containing partly digested blood

Question 10

What is haematemesis?

Answer 10

vomiting up blood

Question 11

Is upper GI endoscopy therapeutic or diagnostic?

Answer 11

can be both

Question 12

Explain the prepping done before an UGIE

Answer 12

fasted before and consented

throat spray for local anaesthetic or sedation

Question 13

What are the risks of an UGIE?

Answer 13

perforation, bleeding or drug reaction

Question 14

What is a perforation of the GI tract?

Answer 14

Hole in the stomach lining

Question 15

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

Answer 15

bloods
drug history
lifestyle

Question 16

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

Answer 16

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

Question 17

What drugs can be associated with dyspepsia?

Answer 17

NSAIDS, steroids

Question 18

What are important lifestyle factors to consider with dyspepsia?

Answer 18

smoking, alcohol, exercise, diet, weight

Question 19

If there are no ALARM symptoms what would you do?

Answer 19

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

Question 20

Describe H pylori

Answer 20

spiral shaped gram negative bacteria

flagellated and microaerophilic

Question 21

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

Answer 21

50% - childhood

Question 22

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

Answer 22

colonise the mucosa and initiate an immune response

Question 23

What are the 3 outcomes of H pylori infection?

Answer 23

asymptomatic or chronic gastritis
ulcer/metaplasia
cancer

Question 24

What is the outcome of H pylori infection dependent on?

Answer 24

site of colonisation
bacteria character
host factors - genetic and environmental

Question 25

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

Answer 25

Nearer the top as decreases acid production and leads to atrophy

Question 26

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

Answer 26

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

Question 27

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

Answer 27

taken off PPI

Question 28

What are the invasive diagnostic procedures for H pylori infections?

Answer 28

endoscopy and biopsy | rapid slide urease test

Question 29

What is gastritis?

Answer 29

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

Question 30

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

Answer 30

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

Question 31

Who is most likely to have a peptic ulcer?

Answer 31

men - elderly

Question 32

What are some causes of peptic ulcers?

Answer 32

previous H pylori infection, smoking and NSAIDS

Question 33

What are the symptoms of peptic ulcers?

Answer 33

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

Question 34

What are the treatment methods for peptic ulcers?

Answer 34

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

Question 35

What is the treatment plan for H pylori?

Answer 35

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

Question 36

What are some complications of H pylori infection?

Answer 36

bleeding, perforation, fibrosis, gastric outlet obstruction

Question 37

What is the vomit like in GOO?

Answer 37

lack bile and fermented

Question 38

What happens to the electrolytes in GOO?

Answer 38

dehydrated and loss of Na/K/Cl in vomit

Question 39

What is the investigation and treatments for GOO?

Answer 39

endoscopy and aspiration of contents | balloon dilation/surgery

Question 40

What are some symptoms of gastric cancer?

Answer 40

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

Question 41

What is the aetiology of gastric cancer?

Answer 41

smoking, diet, genes, H pylori previous infection

Question 42

What are the 3 categories of gastric cancer?

Answer 42

sporadic familial heritable (<1%)

Question 43

How is gastric cancer histologically diagnosed?

Answer 43

endoscopy and biopsy

Question 44

How is gastric cancer staged?

Answer 44

CT

Question 45

How is gastric cancer managed after staging?

Answer 45

MDT discussion | chemotherapy/surgery

Question 46

What structures comprise the upper GI tract?

Answer 46

The oesophagus and stomach

Question 47

What structures comprise the lower GI tract?

Answer 47

small intestine | Large intestine

Question 48

List some functions of the stomach

Answer 48

Food storage Initial digestion Acidic environment Intrinsic factor

Question 49

Does H pylori penetrate the epithelial layer?

Answer 49

No

Question 50

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

Answer 50

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

Question 51

Are duodenal or gastric ulcers more common?

Answer 51

duodenal

Question 52

Rarer causes of peptic ulcers

Answer 52

Zollinger-Ellison syndrome hyperparathyroidism Crohn's disease

Question 53

Why may eradication of H.pylori infection fail?

Answer 53

resistance to antibiotics | Poor concordance