H.pylori and gastric disease Flashcards
what are the group of systems that cause dyspepsia ?
epigastric pain
burning
fullness
bloating
satiety
nausea
sickness
heartburn
reflux
discomfort
how long do you need symptoms for them to be considered as dyspepsia ?
4 weeks
what type of conditions can cause dyspepsia?
GORD
peptic ulcers
gastritis
gastric cancer
non ulcer dyspepsia
pancreatic disease
coeliac
cardio
drugs
psychological
IBS
what are the alarm symptoms of dyspepsia ?
anorexia
loss of weight
anaemia (iron deficicency)
recent onset >55 yrs
melaena/haematemesis
swallowing problems/dysphagia
what are the features of an endoscopy of the upper GI ?
local anaesthetic under day case
1:2000 risk of perforation, bleeding or a reaction to drugs given
what kind of bacteria is helicobacter pylori ?
gram negative spiral flagellated
how much of the world does H.Pylori affect ?
50% mainly acquired in childhood
how does H.pylori infection in the gut colonise ?
resides in the mucosa of the gastric cells and produces urease
urease creates an alkaline pH arround the bacteria (creates ammonia) to allow it to motilise to the epithelium and release toxins to damage the shot
what are some possible clinical outcomes of H.Pylori ?
chronic gastritis, intestinal metaplasua, duodenal and gastric ulcers, gastric cancer and MALT lymphoma
what condition is prone from antral predominant gastritis ?
duodenal disease due to increase in gastric acid
what condition is prone from corpus predominant gastritis ?
gastric cancer from gastric atrophy
how do we test for H.Pylori ?
serology IgG
13c/14c urea breath test
stool antigen test ELISA (need to be off PPI for 2 weeks prior to testing)
invasively an endoscopic biopsy for a rapid slide urease (CLO), if ammonia is present then the biopsy will become a red colour
what can cause gastritis ?
Autoimmune (parietal cells)
bacterial (H.pylori)
chemical (bile/NSAIDS)
what are the common causes of peptic ulcers ?
H.pylori
smoking
NSAIDS
stress
Caffeine
crohns
what are the main symptoms for peptic ulcers ?
epigastric pain
nocturnal/hunger pain
back pain (more common in DU)
nausea and vommiting
weight loss
epigastric tenderness
haematemesis
melaena
anaemia
how do we treat peptic uclers ?
H.pylori eradication therapy
antacid medication (PPI such as omeprazole) or H2RA (ranitidine)
stop NSAIDS
how do we eradicate H.pylori ?
triple therapy for 7 day
clarithromycin 500mg
amoxicillin 1g (or tetracyline 1g, metronidazole 400mg)
PPI such as omeprazole 20mg
what are the main causes of failure for H.pylori eradication ?
resistance to antibiotics
poor compliance
what are the complications of gastric ulcers ?
acute bleeding (melaena)
chronic bleeding (anaemia)
perforation
fibrotic stricture
gastric outlet obstruction
what are the symptoms of gastric outlet obstruction ?
vomiting (lacks bile and fermented food)
abdominal distension
weight loss
gastric splash
dehydration (loss of H+,Cl- in vomit)
what do bloods show in gastric outlet obstruction ?
low Cl, low Na, low K, renal impairment
how do we treat gastric outlet obstruction ?
endoscopic balloon dilatation or surgery
what are the majority of gastric cancers ?
adenocarcinomas
how do patients with gastric cancer present ?
dyspepsia
nausea and vomiting
weight loss
GI bleeding
iron deficient anaemia
gastric outlet obstruction
how do patients with gastric cancer present ?
dyspepsia
nausea and vomiting
weight loss
GI bleeding
iron deficient anaemia
gastric outlet obstruction
what are the main aeitiologies of gastric cancer ?
diet
smoking
helicobacter
genetics
family history
biliary reflux
what are the genetics involved with gastric cancer ?
majority are sporadic
familial <15%
1-3% inheritable through AD, CDH-1, E-cadherin and HDGC
how do we investigate gastric cancer ?
endoscopic biopsies
CT chest/abdo
MDT discussion
how do we treat gastric cancer ?
surgery total/sub total gasterectomy and chemotherapy
