H.Pylori and Gastric Disease Flashcards
What are the functions of the stomach?
Storage Start digestion Acid secretion Secretion of intrinsic factor Secretion of enzymes (e.g pepsin)
What is dyspepsia?
Group of symptoms used to describe pain or discomfort in the upper abdomen
What symptoms are included in dyspepsia?
Heart burn
Bloating
Fullness
What are some upper GI causes of dyspepsia?
Peptic ulcer
Gastric
Non ulcer dyspepsia
Gastric cancer
What is a hepatic cause of dyspepsia?
Gallstones
What are some lower GI causes for dyspepsia?
IBS
Colonic cancer
What is meant by the term organic?
Means there is a structural pathology that is driving the symptoms
What is meant by the term functional disorder?
Structurally everything is okay however not functioning as it should
What are the red flag symptoms that require further investigation?
Anorexia Loss of weight Anaemia Recent onset or persistent despite treatment Melena Swallowing problems
What are the requirements before performing an endoscopy?
Local anaesthetic
Fasted
Gained consent
What are the investigations for presenting dyspepsia?
History Full examination Bloods FBC Ferritin Calcium Glucose Coeliac serum Drug history (NSAIDS ect..) Lifestyle - smoking, alcohol, diet ect..
Is H.pylori gram positive or negative?
Negative
When can H.pylori only colonise?
In the stomach
When would H.pylori be tested for?
When no alarm features are present
Patient is under 55
No UGIE to be performed
What % of the world population is infected with H.pylori?
50%
Where does H.pylori reside in the stomach?
In the surface mucous layer
should not penetrate the epithelium
In 15-20% of those with H.pylori what can develop?
Gastric ulcers
In <1% of those with H.pylori what can develop?
Gastric cancer
If H.pylori lives in the antrum what is more likely to develop?
Ulcer
Where in the stomach is H.pylori more likely to develop in to gastric cancer?
In the body of the stomach
How is diagnosis of H.pylori made non-invasively?
Serology: IgG against H.pylori
Stool antigen test
How is diagnosis of H.pylori made invasively
Requires endoscopy
Histology
Culture of gastric biopsies
CLO
What is gastritis?
Inflammation in the gastric mucosa
What are the 3 types of gastritis?
Autoimmune
Bacterial
Chemical
What is an example of autoimmune gastritis?
Attack on parietal cells
What is an example of bacterial gastritis?
That caused by H.pylori
What is potential cause of chemical gastritis?
NSAIDS
What are the majority of peptic ulcers caused by?
H.pylori infection
Are peptic ulcers more common in men or women?
Men
What is another potential cause of peptic ulcers?
NSAIDS
What are the symptoms of gastric ulcers?
Epigastric pain Pain worse at night Nausea and occasional vomiting Only sign may be epigastric tenderness Haematemesis
What would haematemesis suggest?
Bleeding of the ulcer
What would back pain with gastric ulcers suggest?
May suggest penetration of the posterior DU
What is the investigation for gastric ulcers?
Endoscopy
Why do gastric ulcers have to be biopsied?
To establish that they are benign
What is the treatment for gastric ulcers?
Get rid of H.pylori infection
Anti acid medication
NSAID removal (if applicable)
Surgery in complicated PUD
What is the treatment for eradication of H.pylori infection?
Triple therapy for 7 days
Clarithromycin
Amoxycillin
PPI
Why are PPI part of the triple therapy?
To protect the stomach from excess acid production
How effective is triple therapy for H/pylori treatment?
90%
What are potential complications of Peptic ulcers?
Acute bleeding Chronic bleeding Perforation Fibrotic stricture Gastric outlet obstruction
What would signs of chronic ulcer bleeding be?
Iron deficiency
Anaemia
What would signs of acute ulcer bleeding ben?
Melaena
Hematemesis
Where would the ulcer be located if there was gastric outlet obstruction?
If the pyloric sphincter is affected
What are the symptoms of gastric outlet obstruction?
Vomiting
Easily satiety
Lose weight
Metabolic alkalosis
What is the prognosis of gastric cancer?
5yr survival <20%
Why does gastric cancer present quite late?
Cause it is asymptomatic
What type of cancer are the majority of gastric cancers?
Adenocarcinomas
How does gastric cancer present?
Dyspepsia Early satiety Nausea and vomiting Weight loss GI bleeding Anaemia Gastric outlet obstruction
What is the investigation to diagnose gastric cancer?
Endoscopy with biopsy
What is the investigation to stage gastric cancer?
CT chest and abdo
What are the treatments for gastric cancer?
Surgery
Chemotherapy
What are some aetiologies for gastric cancer?
FH Previous gastric resection Mostly sporadic Biliary reflux Premalignant gastric pathology
