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GI > Helicobacter pylori and Gastric Disease > Flashcards

Helicobacter pylori and Gastric Disease Flashcards

1
Q

Dyspepsia can describe a range of symptoms. List examples

A 
Pain/discomfort in abdomen
Nausea and vomiting
Bloating
Retrosternal pain
Anorexia
Fullness, early satiety
Heartburn
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2
Q

What is the two broad classification of causes of dyspepsia?

A

Organic

Functional

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3
Q

Groups of causes of dyspepsia

A 
Upper GI - peptic ulcer, gastritis, non-ulcer dyspepsia, gastric cancer
Hepatic causes
Gallstones
Pancreatic disease
Lower GI - IBS, colonic cancer
Coeliac
Psychological 
Drugs
Systemic disease
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4
Q

Symptoms that indicate a referral when patient presents with dyspepsia

A 
ALARMS
Anorexia
Loss of weight (unintentional)
Anaemia
Recent onset and over age 55
Melaena, haematemesis
Mass
Swallowing - dysphagia
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5
Q

What investigations are used to diagnose gastric disease?

A

History
Examination
Upper GI Endoscopy
Bloods - FBC, ferritin, LFTs, U&Es, calcium, glucose, coeliac serology/IgA

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6
Q

What drugs and medications are useful in GI history?

A 
NSAIDs
Steroids
Bisphosphonates
Ca antagonists
Nitrates
Theophyllines
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7
Q

Which lifestyle factors need to be addressed in GI history?

A 
Alcohol
Smoking
Diet
Exercise
Weight reduction
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8
Q

When presenting with dyspepsia, which factors indicate testing for H.pylori?

A

No ALARM symptoms

Under 55 years old

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9
Q

What type of bacterium is h pylori?

A

Gram negative, spiral, microaerophillic, flagellated

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10
Q

What tissue does h pylori colonise?

A

Gastric muscosa - burrows into mucus layer, does not penetrate epithelial layer

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11
Q

What substance is produced by h pylori?

A

Urease

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12
Q

4 clinical outcomes of h.pylori infection

A

Asymptomatic or chronic gastritis
Chronic atrophic gastritis - intestinal metaplasia
Gastric or duodenal ulcer
Gastric cancer - MALT lymphoma

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13
Q

Infection resulting in increased acid production will result in which type of disease?

A

Duodenal disease

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14
Q

Infection of h pylori resulting in decreased gastric acid production will result in which type of disease?

A

Gastric cancer - gastric atrophy

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15
Q

Non-invasive diagnostic investigations for h.pylori infection

A

Serology - IgG
13d/14c Urea Breath test
Stool Antigen test - ELISA

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16
Q

Invasive diagnostic investigation for h.pylori infection?

A

ENDOSCOPY
Biopsies
Culture
Rapid slide urease test (changes yellow to pink)

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17
Q

What indicates a positive result in a rapid slide urease test?

A

Change from yellow to pink

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18
Q

How is gastritis diagnosed?

A

Histological diagnosis

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19
Q

What are 3 causes of gastritis?

A

Autoimmune
Bacterial
Chemical

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20
Q

Causes of peptic ulcers

A 
H.pylori
NSAIDs
Smoking
Zollinger-Ellison
Hyperparathyroidism
Crohns
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21
Q

How does hyperparathyroidism lead to peptic ulcer disease?

A

Increased Ca
Increased Ach
Increased Gastrin
Increased gastric acid secretion –> Peptic ulcer

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22
Q

What is Zollinger-Ellison?

A

Gastrin producing neuroendocrine tumour

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23
Q

How does Zollinger Ellison syndrome occur?

A

Sporadic

MEN 1 Associated

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24
Q

Symptoms of zollinger ellsion

A 
Abdominal pain
Diarrhoea
GO reflux
weight loss
bleeding
nausea
vomiting
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25
Q

Diagnostic investigations for zollinger ellison

A

Serum gastrin
Endoscopy
EUS
MRI liver

26
Q

Treatment for zollinger-ellison syndrome

A

PPIs

27
Q

Associated symptoms with peptic ulcer disease

A 
Epigastric pain which is relieved by antacids
Nocturnal/hunger pain
Back pain
Nausea, occasionally vomiting
Weight loss, anorexia
Epigastric tenderness
Haematemesis, melaena, anaemia
28
Q

Treatment of peptic ulcer disease

A

Eradicate h/pylori infection
Antacid medication (PPIs; omeprazole, H2 Receptor antagonists - ranitidine)
Stop NSAID uses
Surgery if complicated

29
Q

What is eradication therapy for h.pylori?

A

Triple therapy
Clarithromycin
Amoxicillin (Metronidazoles)
PPI

30
Q

Complications of peptic ulcer disease

A 
Acute bleeding
Chronic bleeding
Perforation
Fibrotic stricture 
Pyloric stenosis
Gastric outlet obstruction
31
Q

Signs of Gastric outlet obstruction

A 
Vomiting
Early satiety
Abdominal distension
Weight loss
Gastric splash
Dehydration
Metabolic alkalosis
Bloods - low Cl, low Na, low K, renal impairment
32
Q

Diagnostic investigations of Gastric outlet obstruction

A

UGIE

33
Q

Treatment of gastric outlet obstruction

A

Endoscopic balloon dilatation

Surgery

34
Q

5 year survival rate of gastric cancer

A

Less than 20%

35
Q

Most common type of gastric cancer

A

Adenocarcinoma

GI stromal tumor
Mucosa associated lymphoid tumour

36
Q

Signs of gastric cancer

A 
Dyspepsia
Early satiety
Nausea & vomiting
Weight loss
GI bleeding
Iron deficiency anaemia
Gastric outlet obstruction
37
Q

What is the Correa hypothesis?

A

Most sporadic cancers are of intestinal type

38
Q

What perrcentage of gastric cancers are heritable?

A

1-3 %

Hereditary Diffuse Gastric Cancer

39
Q

Mode of inheritance of Hereditary Diffuse Gastric Cancer

A 
Autosomal dominant
CDH1  gene (E-cadherin)
40
Q

Management of gastric cancer

A

Endoscopy and biopsy - Histological diagnosis
Staging investigation - CT chest/abdo
MDT
Treatment - surgery and chemotherapy

41
Q

What is a peptic ulcer?

A

A break in the lining of the GI tract to the muscularis mucosa

42
Q

Most common location of peptic ulcers

A

lesser curvature of the proximal stomach or the first part of the duodenum.

43
Q

Which type of ulcers present earlier?

A

Duodenal - around 20 years

44
Q

How do NSAIDs cause peptic ulcer formation?

A

Inhibit prostaglandin synthesis - reduces glycoprotein, mucous and phospholipid secretion
Lining loses protection from acid

45
Q

What are curling’s ulcer and cushing’s ulcer?

A

Physiological stress- risk factor for peptic ulcer disease
Curling’s - from burns
Cushing’s from head trauma

46
Q

What is the NICE criteria for urgent referral for upper GI Endoscopy (OesophagoGastroDuodenoscopy) ?

A

New onset
Over 55 with weight loss and upper abdominal pain, reflux or dyspepsia
New onset dyspepsia not responding to PPI

47
Q

Classic differentiation between gastric and duodenal ulcers

A

any pain from a gastric ulcer is exacerbated by eating, whilst duodenal ulcers are worse 2-4 hours after eating or even alleviated by eating

48
Q

Differential diagnoses for peptic ulcer disease

A 
ACS
GORD
Gallstone
Gastric malignancy
Pancreatitis
49
Q

Risk factors for gastric cancer

A 
Male
H pylori
Smoking
Increasing Age
Alcohol consumption

Salt in diet
Family history
Pernicious anaemia

50
Q

What is trosier sign?

A

Palpable left supraclavicular node - Virchow’s

Indicates metastatic abdominal malignancy

51
Q

Other signs of metastatic disease

A

Ascites
Hepatomegaly
Jaundice
Acanthosis nigricans

52
Q

What should biopsies be sent for testing in suspected gastric cancer?

A

Histology – for classification and grading of any neoplasia present
CLO test – for the presence of H. Pylori
HER2/neu protein expression – this will allow for targeted monoclonal therapies if present

53
Q

What imaging is needed for TNM staging of gastric cancer?

A

Diagnosis on biopsy from OGD
CT Chest Abdo Pelvis
Laparoscopy

54
Q

What assessment and support is essential in definitive management of gastric cancer?

A

Nutritional status - support with feeding

Dietician will assess

55
Q

Curative treatment for gastric cancer

A

Surgery and perioperative treatment - 3 cycles neoadjuvant and 3 cycles adjuvant

56
Q

Surgical options for gastric cancer

A

Proximal - Total gastrectomy

Distal - subtotal gastrectomy (antrum or pylorus)

57
Q

Most common reconstruction method in alimentary pathology

A

Roux en Y

58
Q

Which surgical option may be offered to patients with T1a gastric cancer?

A

Endoscopic Mucosal Resection

59
Q

Complications of gastrectomy

A 
Death
Anastomotic leak
Re-operation
Dumping syndrome
Vitamin B12 deficiency
60
Q

Palliative management of gastric cancer

A

Chemotherapy
Best Supportive
Stenting

61
Q

Complications of gastric cancer

A

Perforation
Iron deficiency anemia
Malnutrition
Gastric Outlet Obstruction

62
Q

Types of gastrectomy

A

Subtotal
Total with Roux en Y reconstruction
Open gastrectomy
Laparscopic distal gastrectomy

GI (8 decks)

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