H.Pylori and Gastric Disease Flashcards
What is Dyspepsia
Pain or discomfort in the upper abdomen
What is the group of symptoms for dyspepsia
upper abdominal discomfort, retrosternal pain,
anorexia, nausea, vomiting, bloating, fullness,
early satiety heartburn
What are the causes of dyspepsia
Upper GI and lower GI problems
Gallstones
Pancreatic disease
Coeliac disease
hepatic causes
Psychological
Drugs
Other systemic diseases
When should refer someone with dyspepsia for an endoscopy
Anorexia
Loss of weight
Anaemia – iron deficiency
Recent onset >55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia
What features from a history do you need to find out for a patient with dyspepsia
Drugs - do they take any NSAIDS
Lifestyle:
Alcohol, diet, smoke, exercise, weight reduction
What bloods are investigated in dyspepsia diagnosis
FBC
ferritin- iron storage
Liver Function Tests
U&Es
calcium
glucose
coeliac serology/serum IgA
What Bacterial test in important in diagnosis dyspepsia
Test for Heliobacter pylori
What is the treatment if patient with dyspepsia is
Eradication therapy if H.Pylor positive
Treat symptoms with proton pump inhibitors H2R antagonists and lifestyle factors
stop NSAID
Where can H. Pylori only colonise
Gastric type mucosa
- therefore resides on mucus layer without penetrating epithelial layer
How and where does the H.pylori affect
Evokes an immune response form the underlying mucosa
What does the immune response to the H.pylori depend on
site of colonization,
characteristics of bacteria - express different proteins
genetic susceptibility
environmental factors e.g. smoking
H.Pylori infection in what part of the stomach increases acid production and has a low risk of gastric cancer
Duodenum
What are three non invasive procedures to test for H.pylori
Serology - test for IgG
Urea Breath test
Stool antigent test (need to be of PPI 2 weeks prior)
What is the invasive procedure to test for H.Pylor
An Endoscopy:
For Histology or
Culture of gastric biopsies
Rapid slide urease test (CLO)
Why is Urea tested for in H.Pylori diagnosis
As H.Pylori releases Urease enzyme that breaks down urea into ammonia and bicarbonate
What dies the Urease slide test exactly test for
Ammonia
What does the the Urea breath test exactly test for
CO2 in your breath
What is the aetiology of peptic ulceration
H.Pylori
NSAIDS
Smoking
Rare:
Zollinger-Ellison syndrome, hyperparathyroidism, Crohn’s disease
How does H.Pylori infection increase the acid production
and where is the most likely to occur
Gastric atrophy
Occurs in body and antrum
What are the symptoms associate with peptic ulcers
Epigastric pain
Nocturnal/hunger
pain
Back pain
Nausea/vomiting
Weight loss/anorexia
epigastric tenderness
What are the potential symptoms if the ulcer bleeds
haematemesis
melaena
anaemia
How can back pain occur in peptic ulceration
If duodenal ulcer penetrates the posterior
How is the symptoms of epigastric pain relived
Antacids:
Proton pump inhibitor eg omeprazole
H2 receptor antagonists eg ranitidine
What is the treatment of Peptic ulcer caused by H.Pylori infection
Eradication
therapy
Surgery - if complicated
What medication needs to be stopped in Peptic ulceration
NSAIDS
What happens in eradication therapy of H.Pylori infection
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
What is the complication of peptic ulceration
Acute/chronic bleeding
Perforation
Fibrotic stricture (narrowing)
Gastric outlet obstruction (leads to oedema or stricture)
What is the symptoms of Gastric outlet obstruction
Vomiting – lacks bile, fermented foodstuffs
Early satiety, abdominal distension, weight loss, gastric splash
Dehydration
How does metabolic alkalosis occur in gastric outlet obstruction
Due to the loss of H and Cl ions through vomiting
What is the result of a blood test for gastric outlet obstruction
low Cl, low Na, low K, renal impairment
What is the causes of gastric outlet obstruction
Stricture
Ulcer
Cancer
What is the potential treatment go gastric outlet obstruction
Endoscopic ballon microscopy
Surgery
How is Gastric outlet obstruction diagnosed
Endoscopy
What is the symptoms of gastric cancer
Dyspepsia, early satiety, nausea & vomiting, weight loss, GI bleeding (iron deficiency /anaemia) gastric outlet obstruction
What is the aetiology of Gastric cancer
Diet
Genetics (however most sporadic)
Previous gastric resection
Billary reflux
Smoking
H.Pylori infection
Peptic ulcer
Pre malignant gastric pathology
What is oncogenes that cause the 1-3% of heritable gastric cancers
HDGC
AD
CDH1
(E-cadherin)
What is the two pathways of gastric cancer
Intestinal type
Diffuse type
How do you make a histological diagnosis of gastric cancer
endoscopy and biopsies
How do you determine the staging of gastric caner
Use imaging to see if its spread
Asses patients fitness
Determine the histology
What imaging technique is used to determine if gastric cancer has spread
Ct of chest/abdomen
Where are the potential places that gastric cancer can spread
lymph nodes liver lungs peritoneum bone marrow
How do you treat gastric cancer
Surgical and chemotherapy
What cell type of gastric cancer
Adenocarcinoma
