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Alimentary System: Pathology SA > H.Pylori and Gastric Disease > Flashcards

H.Pylori and Gastric Disease Flashcards

1
Q

What is Dyspepsia

A

Pain or discomfort in the upper abdomen

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2
Q

What is the group of symptoms for dyspepsia

A

upper abdominal discomfort, retrosternal pain,
anorexia, nausea, vomiting, bloating, fullness,
early satiety heartburn

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3
Q

What are the causes of dyspepsia

A

Upper GI and lower GI problems

Gallstones

Pancreatic disease

Coeliac disease

hepatic causes

Psychological

Drugs

Other systemic diseases

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4
Q

When should refer someone with dyspepsia for an endoscopy

A

Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia

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5
Q

What features from a history do you need to find out for a patient with dyspepsia

A

Drugs - do they take any NSAIDS

Lifestyle:
Alcohol, diet, smoke, exercise, weight reduction

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6
Q

What bloods are investigated in dyspepsia diagnosis

A

FBC

ferritin- iron storage

Liver Function Tests

U&Es

calcium

glucose

coeliac serology/serum IgA

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7
Q

What Bacterial test in important in diagnosis dyspepsia

A

Test for Heliobacter pylori

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8
Q

What is the treatment if patient with dyspepsia is

A

Eradication therapy if H.Pylor positive

Treat symptoms with proton pump inhibitors H2R antagonists and lifestyle factors

stop NSAID

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9
Q

Where can H. Pylori only colonise

A

Gastric type mucosa

- therefore resides on mucus layer without penetrating epithelial layer

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10
Q

How and where does the H.pylori affect

A

Evokes an immune response form the underlying mucosa

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11
Q

What does the immune response to the H.pylori depend on

A

site of colonization,

characteristics of bacteria - express different proteins

genetic susceptibility

environmental factors e.g. smoking

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12
Q

H.Pylori infection in what part of the stomach increases acid production and has a low risk of gastric cancer

A

Duodenum

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13
Q

What are three non invasive procedures to test for H.pylori

A

Serology - test for IgG

Urea Breath test

Stool antigent test (need to be of PPI 2 weeks prior)

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14
Q

What is the invasive procedure to test for H.Pylor

A

An Endoscopy:
For Histology or
Culture of gastric biopsies

Rapid slide urease test (CLO)

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15
Q

Why is Urea tested for in H.Pylori diagnosis

A

As H.Pylori releases Urease enzyme that breaks down urea into ammonia and bicarbonate

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16
Q

What dies the Urease slide test exactly test for

A

Ammonia

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17
Q

What does the the Urea breath test exactly test for

A

CO2 in your breath

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18
Q

What is the aetiology of peptic ulceration

A

H.Pylori
NSAIDS
Smoking

Rare:
Zollinger-Ellison syndrome, hyperparathyroidism, Crohn’s disease

19
Q

How does H.Pylori infection increase the acid production

and where is the most likely to occur

A

Gastric atrophy

Occurs in body and antrum

20
Q

What are the symptoms associate with peptic ulcers

A

Epigastric pain

Nocturnal/hunger
pain

Back pain
Nausea/vomiting
Weight loss/anorexia

epigastric tenderness

21
Q

What are the potential symptoms if the ulcer bleeds

A

haematemesis
melaena
anaemia

22
Q

How can back pain occur in peptic ulceration

A

If duodenal ulcer penetrates the posterior

23
Q

How is the symptoms of epigastric pain relived

A

Antacids:

Proton pump inhibitor eg omeprazole

H2 receptor antagonists eg ranitidine

24
Q

What is the treatment of Peptic ulcer caused by H.Pylori infection

A

Eradication
therapy

Surgery - if complicated

25
Q

What medication needs to be stopped in Peptic ulceration

A

NSAIDS

26
Q

What happens in eradication therapy of H.Pylori infection

A

Tripple therapy of Clarithromycin 500mg bd

Amoxycillin 1g bd or Metronidazole 400mg bd
(tetracycline if penicillin allergic)

PPI: e.g. omeprazole 20mg bd

For 7 days

27
Q

What is the complication of peptic ulceration

A

Acute/chronic bleeding

Perforation

Fibrotic stricture (narrowing)

Gastric outlet obstruction (leads to oedema or stricture)

28
Q

What is the symptoms of Gastric outlet obstruction

A

Vomiting – lacks bile, fermented foodstuffs

Early satiety, abdominal distension, weight loss, gastric splash

Dehydration

29
Q

How does metabolic alkalosis occur in gastric outlet obstruction

A

Due to the loss of H and Cl ions through vomiting

30
Q

What is the result of a blood test for gastric outlet obstruction

A

low Cl, low Na, low K, renal impairment

31
Q

What is the causes of gastric outlet obstruction

A

Stricture
Ulcer
Cancer

32
Q

What is the potential treatment go gastric outlet obstruction

A

Endoscopic ballon microscopy

Surgery

33
Q

How is Gastric outlet obstruction diagnosed

A

Endoscopy

34
Q

What is the symptoms of gastric cancer

A 
Dyspepsia, early satiety, nausea & vomiting, weight loss,
 GI bleeding (iron deficiency /anaemia) gastric outlet obstruction
35
Q

What is the aetiology of Gastric cancer

A

Diet

Genetics (however most sporadic)

Previous gastric resection

Billary reflux

Smoking

H.Pylori infection

Peptic ulcer

Pre malignant gastric pathology

36
Q

What is oncogenes that cause the 1-3% of heritable gastric cancers

A

HDGC
AD
CDH1
(E-cadherin)

37
Q

What is the two pathways of gastric cancer

A

Intestinal type

Diffuse type

38
Q

How do you make a histological diagnosis of gastric cancer

A

endoscopy and biopsies

39
Q

How do you determine the staging of gastric caner

A

Use imaging to see if its spread

Asses patients fitness

Determine the histology

40
Q

What imaging technique is used to determine if gastric cancer has spread

A

Ct of chest/abdomen

41
Q

Where are the potential places that gastric cancer can spread

A 
lymph nodes 
liver
lungs
peritoneum
bone marrow
42
Q

How do you treat gastric cancer

A

Surgical and chemotherapy

43
Q

What cell type of gastric cancer

A

Adenocarcinoma

Alimentary System: Pathology SA (27 decks)

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