Helicobacter Pylori and Gastric Disease Flashcards by Liam Lennox

What parts of the GI tract are considered to be upper GI tract?

Oesophagus

Stomach

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What parts of the GI tract are considered to be lower GI tract?

Small intestine

Large intestine

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What are the layers of the muscularis externa of the stomach?

Oblique muscle

Circular muscle

Longitudinal muscle

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What are the folds in the stomach called?

Rugae

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What are the functions of the stomach?

Food storage

Initial digestive processes

Acidic environment for defence

Secretion of gastric acid and gut hormones, intrinsic factor and pepsin

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What is dyspepsia?

Describes a group of symptoms, pain or discomfort in the upper abdomen (indigestion)

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What are the symptoms under the umbrella term dyspepsia?

Upper abdominal discomfort

Retrosternal pain

Anorexia

Nausea

Vomiting

Bloting

Fullness

Early satiety

Heartburn

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What are the 2 categories of dyspepsia?

Organic or functional

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What are examples of diseases that can cause dyspepsia?

Upper GI:

GORD

Peptic ulcer

Gastritis

Non ulcer dyspepsia

Gastric cancer

Gallstones

Pancreatic disease

Coelic disease

Drugs

Psychological

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What are the steps you should follow if a patient presents with dyspepsia?

1) History and examination
2) Bloods
3) Drugs history
4) Lifestyle

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What bloods should be done for a patient presenting with dyspepsia?

FBC

Ferritin

LFTs

U&Es

Calcium

Glucose

Coeliac serology/serum IgA

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What do U&E blood tests measure?

Urea

Electrolytes (sodium and potasium) and creatinine

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What drugs should be asked about when a patient presents with dyspepsia?

NSAIDs

Steroids

Biphosphonates

Ca antagonists

Nitrates

Theophyllines

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What lifestyle factors should be asked about when a patient presents with dyspepsia?

Alcohol

Diet

Smoking

Exercise

Weight

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When should a patient be refered for an endoscopy once they present with dyspepsia?

Anorexia

Loss of weight

Anaemia

Recent onset (>55 years or persistent despite treatment)

Melaena/haematemesis or mass

Dysphagia

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What is the production of dark, sticky faeces containing partly digested blood called?

Melaena

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What is the vomiting of blood called?

Haematemesis

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What are difficulties swallowing called?

Dysphagia

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What are some risks of getting an upper GI endoscopy?

Perforation

Bleeding

Reaction to drugs given

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What are the options for anaesthetic for an upper GI endoscopy?

Local anaesthetic (throat spray) or sedation

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Should food be eaten before an upper GI endoscopy?

No, the patient should be fasted

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What are characteristics of helicobacter pylori?

Gram negative

Spiral-shaped

Microaerophilic

Flagellated

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What is a microaerophilic organism?

One that requires oxygen to live

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What percentage of the world population is infected with helicobacter pylori?

50%

When is helicobacter pylori acquired?

Childhood

Where does helicobacter pylori colonise?

Gastric type mucosa Resides in surface mucous layer and does no penetrate the epithelial layer

Why does helicobacter pylori not always evoke the immune response in underlying mucosa?

Dependant on host genetic factors

What does the clinical outcome of an infection with helicobacter pylori depend on?

Site of colonisation Characteristics of bacteria Host factors such as genetic susceptibility Environment factors such as smoking

What are the potential clinical outcomes of a helicobacter pylori infection?

Explain the pathogenesis of helicobacter pylori infection?

1) Enters host and survival 2) Motility and chemotaxis 3) Adhesion-receptor interact to establish colonisation 4) Toxins release and cause damage to host 5) Possible intracellular replication

What is the movement of motile cells or organisms called?

Chemotaxis

What is the likely response of helicobacter pylori infection of the antrum?

Increase in acid production Low risk of gastric cancer Results in DU disease

What is the likely response of the helicobacter pylori infection of the corpus?

Decrease in acid production Gastric atrophy Causes gastric cancer

What are the 2 broad categories of diagnosing helicobacter pylori infection?

Invasive Non-invasive

What are non-invasive methods or diagnosing helicobacter pylori infection?

Serology (IgG against H.Pylori) 13^C/14^C urea breath test Stool antigen test, ELISA

What are invasive methods of diagnosing helicobacter pylori infection?

Requires endoscopy Histology, gastric biopsies stained for the bacteria Culture of gastric biopsies Rapid slid urease test (CLO)

What is utilised in slide urease tests such as CLO for diagnosing helicobacter pylori infection?

Ammonia

What is utilised in breast tests for diagnosing helicobacter pylori infection?

¹³C or ^14Clabelled CO₂

What is inflammation of the gastric mucosa called?

Gastritis

How is gastritis diagnosed?

Histologically

What are the broad categories of things that can cause gastritis?

Autoimmune (parietal cells) Bacterial (helicobacter pylori) Chemical (bile/NSAIDs)

How is the incidence of peptic ulcers changing?

Incidence is decreasing in most developed countries

How does the incidence of peptic ulcers change between men and women?

Men affected more than women

Which of duodenal ulcer and gastric ulcer is more common?

Duodenal ulcer

What are some examples of causes of peptic ulcers?

Helicobacter pylori infection (main cause) NSAIDs Smoking Other conditions such as Zollinger-Ellison syndrome, hyperparathyroidism, Crohn's disease

What is the main cause of peptic ulcers?

Helicobacter pylori infection

What are examples of other conditions that can cause peptic ulcers?

Zollinger-Ellison syndrome Hyperparathyroidism Crohn's disease

What are some symptoms of peptic ulcer?

Epigastric pain (main feature) Nocturnal/hunger pain (more common in DU) Back pain Nausea and occasional vomiting Weight loss and anorexia Only sign may be epigastric tenderness If the ulcer bleeds patients may present with haematemesis and/or malaena or anaemia

What is the treatment of peptic ulcers?

Ones caused by H.Pylori are treated by eradication therapy Antacid medication If NSAIDs are involved they have to be stopped if possible Complications treated as they arise Surgery is only indicated in complication

How is helicobacter pylori infection eradicated?

Triple therapy: Clarithromycin 500mg Amoxycillin 1g (or tetracycline if penicillin allergy) PPI such as omeprazole 20mg

What are medications that neutralise acid in the stomach called?

Antacids

What are the main reasons for eradication of helicobacter pylori infection?

Resistance to antibiotics and poor compliance

What are some possible complication of peptic ulcer?

Acute bleed (melaena and haematemesis) Chronic bleed (iron deficiency anaemia) Perforation Fibrotic stricture (narrowing) Gastric outlet obstruction (oedema or stricture)

What are signs and symptoms of gastric outlet obstruction?

Vomiting, lacks bile and fermented foodstuff Early satiety, abdominal distension, weight loss and gastric splash Dehydration and loss of H⁺ and Cl^- in vomit Metabolic alkalosis

What can be seen in bloods during gastric outlet obstruction?

Low Cl Low Na Low K Renal impairment

What does diagnosis of gastric outlet obstruction require?

UGIE (prolonged fast/aspiration of gastric contents) and identifies the cause (stricture, ulcer, cancer)

What is used to treat gastric outlet obstruction?

Endoscopic balloon dilation

In terms of GI cancers, how does gastric cancer rask for prevalence?

Second commonest

Why is there a large geographic variation in gastric cancer incidence?

Genetic and environmental factors

What is the prognosis of gastric cancer?

Very poor \<20% 5 year survival

What is the histology of gastric cancer normally?

Adenocarcinoma

Other than adenocarcinoma, what are other kinds of gastric tumours?

MALT GIST

What do patients with gastric cancer present with?

Dyspepsia Early satiety Nausea and vomiting Weight loss GI bleeding Iron deficiency anaemia Gastric outlet obstruction

What is the aetiology of gastric cancer?

Diet Genetics Smoking Family history Previous gastric resection Biliary reflux Premalignant gastric pathology

What are the histopathological subtypes of gastric cancer?

Intestinal type Diffuse type

Are the majority of sporadic gastric cancers intestinal type or diffuse type?

Intestinal type

What is required to make the diagnosis of gastric cancer?

Histological diagnosis by endoscopy and biopsy

What is used to stage gastric cancer?

CT of chest/abdomen to check lymph nodes and liver/lung/peritoneum/bone marrow involvement

Who is involved in the discussion for the treatment of gastric cancer?

Multi-disciplinary team

What people are in the MDT for the treatment of gastric cancer?

Gastroenterologist Pathologist Radiologist Upper GI surgeons Oncologists Specialist nurses

What must the MDT discuss about the treatment of gastric cancer?

Imaging, histology, patient fitness, treatment options

What is the treatment of gastric cancer?

Surgical and chemotherapy