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Alimentary Clinical medicine > Helicobacter Pylori and Gastric disease > Flashcards

Helicobacter Pylori and Gastric disease Flashcards

1
Q

what is dyspepsia?

A

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

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2
Q

what are the symptoms of dyspepsia?

A 
upper abdominal pain or discomfort
retrosternal pain
nausea
vomiting
anorexia
early satiety 
bloating
fullness
heart burn
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3
Q

What are some of the causes of dyspepsia?

A

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

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4
Q

what is the difference between organic and functional dyspepsia?

A

organic- there is a known structural pathology which is affecting its function
functional - the structure is completely normal but doesn’t function properly

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5
Q

when do you refer for endoscopy when patients present with dyspepsia?

A 
Anorexia
Loss of weight
Anaemia - iron deficiency
Recent onset > 50yrs or persistence even with treatment
Malaena / haematomesis 
Mass
Swallowing difficulty (dysphagia)
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6
Q

what are some of the blood tests which would be carried out when someone presents with dyspepsia?

A 
FBC
U&E
LFT's
Ferritin
Calcium
Glucose
Coeliac serology/serum IgA
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7
Q

what are some of the drugs you would ask in a history of someone who has presented with dyspepsia?

A 
NSAID's
steroids
biphosphomates
theophyllines
Ca antagonists
nitrates
over the counter medications
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8
Q

40 year old patient presents with dyspepsia but no ALARM signs. what is the next step?

A

don’t do upper GI endoscopy

test for helicobacter pylori infection

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9
Q

what type of bacteria is H.pylori?

A

gram negative
microaerophillic
flagellated

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10
Q

where does h.pylori reside?

A

on the surface of the gastric mucosa

doesn’t penetrate the epithelium

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11
Q

what is a protective mechanism of h.pylori which is a target for treatment?

A

produces the enzyme urease which breaks down urea to produce a protect alkaline layer

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12
Q

what are some of the clinical complications from infection of h.pylori?

A

chronic gastritis
gastric or duodenal ulcer
gastric cancer
intestinal metaplasia

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13
Q

what does the outcome of h.pylori depend on?

A

site of infection/colonisation
characteristics of bacteria
host factors i.e. genetic susceptibility, environmental i.e. smoking

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14
Q

where in the stomach would h.pylori colonise which would cause gastric cancer? and where to cause duodenal ulcer?

A

gastric cancer = body

duodenal ulcer = antrum

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15
Q

how does colonisation of h.pylori in the stomach body cause gastric cancer?

A

causes a decrease in gastric acid and gastric atrophy

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16
Q

what are the main invasive and non-invasive tests used to diagnose H. pylori infection?

A 
non-invasive = urea breath test & stool antigen test
invasive = endoscopy - gastric biopsy and culture of biopsies, rapid slide urease test (CLO)
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17
Q

what are the urease dependant tests for diagnosing h. pylori?

A

rapid slide urease test

urea breath test

18
Q

what is the aetiology of peptic ulcers?

A 
h.pylorus infection
smoking
diet - rich in nitrates
zollingers-ellison syndrome
hyperparathyroidism
crohn's disease
19
Q

what are the symptoms of peptic ulcers?

A 
epigastric pain
back pain
nocturnal hunger pain
nausea
occasionally vomiting
weightless 
anorexia
20
Q

what symptoms occur if the peptic ulcer bleeds?

A

malaena

haematomesis

21
Q

what is the treatment for peptic ulcers?

A

eradication therapy if infection

antacids - PPI and h2 receptor antagonist

22
Q

what are the complications of peptic ulcers?

A 
acute bleeding
chronic bleeding
gastric outlet obstruction
perforation
fibrotic stricture
23
Q

what are the symptoms of gastric outlet obstruction?

A 
vomiting
early satiety
abdominal distension
weight loss
gastric splash
24
Q

what is the presentation of gastric outlet obstruction?

A

dehydration and loss of H and Cl (through vomit)
metabolic alkalosis
low Na , K and Cl
renal impairement

25
Q

how is gastric outlet obstruction treated?

A

endoscopic balloon dilatation or surgery

26
Q

what is eradication therapy?

A

used in the treatment of ulcers caused by infection

involved 2 antibiotics plus a Proton pump inhibitor

27
Q

what is the aetiology of gastric cancer?

A 
most common - H.pyloris infection
multifactorial environmental and genetic;
smoking
diet - nitrate rich
previous gastric resection
biliary reflux
premalignant gastric pathology
family history
28
Q

what is the presentation of gastric cancer?

A

dyspepsia
GI bleed
iron deficient anaemia
gastric outlet obstruction

29
Q

what are 2 investigations carried out to diagnose stomach cancer?

A

Upper gastrointestinal endoscopy and biopsy

Computed tomography of abdomen / pelvis

30
Q

what is the name of the surgery which is performed on gastric cancer?

A

subtotal gastrectomy

total gastrectomy with roux en y construction

31
Q

what improves survival with having a gastrectomy?

A

if the lymph nodes and fatty tissue is removed

32
Q

what are the conduits for gastrectomy?

A

small bowel

33
Q

then is someone referred for an endoscopy?

A

when they have alarm features or have some symptoms and are > 55

34
Q

what type of cancer is gastric cancer?

A

adenocarcinoma

35
Q

what is hereditary susceptibility like in gastric cancer?

A

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

36
Q

in what condition would you find a gastric splash?

A

gastric outlet obstruction

37
Q

what is the prognosis of gastric cancer?

A

5yr survival <20%

38
Q

by which four routes does gastric cancer spread?

A

direct spread
transcoelomic spread
haemategenous spread
lymphatic spread

39
Q

What is the aetiology of gastritis?

A

Autoimmune
Bacterial i.e. h.pylori
Chemical i.e. NSAIDS, bile reflux

40
Q

What is the eradication therapy?

A

2 antibiotics + PPI

Clarithromycin, amoxicillin & omeprazole

Alimentary Clinical medicine (23 decks)

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