Helicobacter Pylori and Gastric disease Flashcards
what is dyspepsia?
means bad digestion
it is a term used for a group of symptoms
about 80% of people who present with dyspepsia have no serious underlying disease
what are the symptoms of dyspepsia?
upper abdominal pain or discomfort retrosternal pain nausea vomiting anorexia early satiety bloating fullness heart burn
What are some of the causes of dyspepsia?
upper GI: peptic ulcer, non ulcer dyspepsia, gastritis, stomach cancer
hepatic disease
gallbladder
pancreatic disease
coeliac disease
lower GI: IBS, colonic cancer
systemic causes - metabolic and cardiac diseases, psychological, drugs
what is the difference between organic and functional dyspepsia?
organic- there is a known structural pathology which is affecting its function
functional - the structure is completely normal but doesn’t function properly
when do you refer for endoscopy when patients present with dyspepsia?
Anorexia Loss of weight Anaemia - iron deficiency Recent onset > 50yrs or persistence even with treatment Malaena / haematomesis Mass Swallowing difficulty (dysphagia)
what are some of the blood tests which would be carried out when someone presents with dyspepsia?
FBC U&E LFT's Ferritin Calcium Glucose Coeliac serology/serum IgA
what are some of the drugs you would ask in a history of someone who has presented with dyspepsia?
NSAID's steroids biphosphomates theophyllines Ca antagonists nitrates over the counter medications
40 year old patient presents with dyspepsia but no ALARM signs. what is the next step?
don’t do upper GI endoscopy
test for helicobacter pylori infection
what type of bacteria is H.pylori?
gram negative
microaerophillic
flagellated
where does h.pylori reside?
on the surface of the gastric mucosa
doesn’t penetrate the epithelium
what is a protective mechanism of h.pylori which is a target for treatment?
produces the enzyme urease which breaks down urea to produce a protect alkaline layer
what are some of the clinical complications from infection of h.pylori?
chronic gastritis
gastric or duodenal ulcer
gastric cancer
intestinal metaplasia
what does the outcome of h.pylori depend on?
site of infection/colonisation
characteristics of bacteria
host factors i.e. genetic susceptibility, environmental i.e. smoking
where in the stomach would h.pylori colonise which would cause gastric cancer? and where to cause duodenal ulcer?
gastric cancer = body
duodenal ulcer = antrum
how does colonisation of h.pylori in the stomach body cause gastric cancer?
causes a decrease in gastric acid and gastric atrophy
what are the main invasive and non-invasive tests used to diagnose H. pylori infection?
non-invasive = urea breath test & stool antigen test invasive = endoscopy - gastric biopsy and culture of biopsies, rapid slide urease test (CLO)
what are the urease dependant tests for diagnosing h. pylori?
rapid slide urease test
urea breath test
what is the aetiology of peptic ulcers?
h.pylorus infection smoking diet - rich in nitrates zollingers-ellison syndrome hyperparathyroidism crohn's disease
what are the symptoms of peptic ulcers?
epigastric pain back pain nocturnal hunger pain nausea occasionally vomiting weightless anorexia
what symptoms occur if the peptic ulcer bleeds?
malaena
haematomesis
what is the treatment for peptic ulcers?
eradication therapy if infection
antacids - PPI and h2 receptor antagonist
what are the complications of peptic ulcers?
acute bleeding chronic bleeding gastric outlet obstruction perforation fibrotic stricture
what are the symptoms of gastric outlet obstruction?
vomiting early satiety abdominal distension weight loss gastric splash
what is the presentation of gastric outlet obstruction?
dehydration and loss of H and Cl (through vomit)
metabolic alkalosis
low Na , K and Cl
renal impairement
how is gastric outlet obstruction treated?
endoscopic balloon dilatation or surgery
what is eradication therapy?
used in the treatment of ulcers caused by infection
involved 2 antibiotics plus a Proton pump inhibitor
what is the aetiology of gastric cancer?
most common - H.pyloris infection multifactorial environmental and genetic; smoking diet - nitrate rich previous gastric resection biliary reflux premalignant gastric pathology family history
what is the presentation of gastric cancer?
dyspepsia
GI bleed
iron deficient anaemia
gastric outlet obstruction
what are 2 investigations carried out to diagnose stomach cancer?
Upper gastrointestinal endoscopy and biopsy
Computed tomography of abdomen / pelvis
what is the name of the surgery which is performed on gastric cancer?
subtotal gastrectomy
total gastrectomy with roux en y construction
what improves survival with having a gastrectomy?
if the lymph nodes and fatty tissue is removed
what are the conduits for gastrectomy?
small bowel
then is someone referred for an endoscopy?
when they have alarm features or have some symptoms and are > 55
what type of cancer is gastric cancer?
adenocarcinoma
what is hereditary susceptibility like in gastric cancer?
most gastric cancers are sporadic
however there is shown to be <15% of family clusters but no definitive mutation
1-3% is heritable syndromes –> HDGC:AD & CDH-1 gene
in what condition would you find a gastric splash?
gastric outlet obstruction
what is the prognosis of gastric cancer?
5yr survival <20%
by which four routes does gastric cancer spread?
direct spread
transcoelomic spread
haemategenous spread
lymphatic spread
What is the aetiology of gastritis?
Autoimmune
Bacterial i.e. h.pylori
Chemical i.e. NSAIDS, bile reflux
What is the eradication therapy?
2 antibiotics + PPI
Clarithromycin, amoxicillin & omeprazole
