Helicobacter pylori and gastric disease Flashcards
What is dyspepsia?
A group of symptoms rather than a disease
What symptoms come under the term dyspepsia?
Upper abdo discomfort Retrosternal pain Anorexia Nausea Vomiting Bloating Bloating Fullness Early satiety Heartburn
What can cause dyspepsia in the upper GI tract?
Peptic ulcer
Gastritis
Non ulcer dyspepsia
Gastric cancer
What can cause dyspepsia in the lower GI tract?
IBS
Colonic cancer
What are the non GI tube causes of dyspepsia?
Hepatic causes Gallstones Pancreatic disease Coeliac Metabolic and cardiac diseases Drugs Psychological
When would a patient presenting with dyspepsia be referred for an endoscopy?
Anorexia Loss of weight Anaemia Recent onset or persistent despite treatment Melaena or haematemesis
What would be done if a patient presented with dyspepsia?
History and exam
Bloods
Drug history
Lifestyle history
What bloods would be done on a patient presenting with dyspepsia?
FBC Ferritin LFTs U+Es Ca Glucose Coeliac serology
What drugs would you look out for in a patient presenting with dyspepsia?
NSAIDs Steroids Bisphosphates Ca antagonists Nitrates Theophyllines
What lifestyle elements would you look out for in a patient presenting with dyspepsia?
Alcohol Diet Smoking Exercise Weight reduction
What is Heliocobacter pylori?
Gram negative, microaerophillic flagellated spiral shaped bacteria
Where does H pylori reside?
Gastric type mucosa in surface mucus layer
What are the outcomes of H pylori colonisation?
80%- asymptomatic or have chronic gastritis
19%- Gastric/duodenal ulcers or chronic atrophic gastritis
1%- gastric cancer
What is the outcome of H pylori colonisation dependent on?
Site of colonisation
Characteristics of bacteria
Host factors
Environmental factors
What are the noninvasive methods of diagnosis for H pylori infection?
IgG against H pylori
Urea breath test
Stool antigen test
What are the invasive methods of diagnosis for H pylori infection?
Endoscopy
How is endoscopy used for diagnosis of H pylori?
Gastric biopsies stained and/or cultured
Rapid slide urease test
What is gastritis?
Inflammation of gastric mucosa
What are peptic ulcers caused by?
H pylori most commonly
NSAIDs, smoking
Rarely caused by other conditions
What are the symptoms of peptic ulcers?
Epigastric pain Nocturnal/hunger pain Back pain Nausea and vomiting Weight loss and anorexia Epigastric tenderness Haemetemesis and/or melaena and/or anaemia
What is the treatment for peptic ulcers?
Eradicate H pylori if present
Antacid medication
Stop NSAIDs
Surgery in severe cases
How is H pylori eradicated in peptic ulcers?
Triple therapy for 7 days- clairythromycin, amoxicillin (or tetracycline) and a proton pump inhibitor e.g. omeprazole
What are the 2 kinds of antacid used in treatment of peptic ulcers?
Proton pump inhibitors
H2 receptor antagonists
How are peptic ulcers treated in a patient who needs to remain on their NSAIDs?
As usual but NSAIDs carried on with extra protection
What are the complications of peptic ulcers?
Acute bleeding Chronic bleeding Perforation Fibrotic structure causing narrowing Gastric outlet obstruction
What are the possible symptoms of acute bleeding in peptic ulcers?
Haemetemesis
Melaena
What is the possible effect of chronic bleeding in peptic ulcers?
Iron deficiency anaemia
What are the symptoms of gastric outlet obstruction?
Recurrent vomiting Early satiety Abdo distension Weight loss Gastric splash Dehydration Loss of H+ and Cl- Metabolic alkalosis
How can vomiting causing by gastric outlet obstruction be identified?
Lacks bile
Contains fermented foods
What would bloods of a patient with gastric outlet obstruction show?
Low CL, Na and K
Renal impairment
How is gastric outlet obstruction diagnosed?
Endoscopy
What are the causes of gastric outlet obstruction?
Stricture
Ulcer
Cancer
How is gastric outlet obstruction treated?
Balloon dilatation in stricture
Surgery
What is the presentation of gastric cancer?
Dyspepsia Early satiety Nausea and vomiting Weight loss GI bleeding Anaemia Gastric outlet obstruction
What are the causes of gastric cancer?
Diet Genetics H pylori Previous gastric resection Biliary reflux Premalignant gastric pathology
How is gastric cancer diagnosed?
Endoscopy
Biopsies
What staging investigation is done for gastric cancer?
CT chest/adbo
Where does gastric cancer primarily spread to?
Lymph nodes
Liver/lungs
Peritoneum
Bone marrow
What is the treatment of gastric cancer?
Surgical and chemo
