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H.Pylori and gastric disease Flashcards

1
Q

name some gastric disorders

A

dyspepsia
peptic ulcer disease
gastric outlet obstruction
gastric cancer

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2
Q

what is dyspepsia

A

translate from greek = “bad digestion”

describes a group of symptoms:

  • pain or discomfort in the upper abdomen
  • retrosternal pain
  • anorexia
  • vomiting
  • bloating
  • fullness
  • early satiety
  • heartburn
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3
Q

what can cause the symptom of dyspepsia

A

upper GI

  • peptic ulcer
  • gastritis
  • non-ulcer dyspepsia
  • gastric cancer

hepatic

gallstones

pancreatic disease

lower GI

  • IBS
  • colonic cancer

coeliac disease

psychological

drugs

other systemic causes

  • metabolic
  • cardiac
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4
Q

what are red flag signs to refer of endoscopy (think ALARMS)

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 initial investigations should be done if a patient is dyspepsic

A

Bloods – FBC, ferritin, LFTs, U&Es, calcium, glucose, coeliac serology/serum IgA

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6
Q

what should be asked in a history for a patient with dyspepsia

A

Drug history – NSAIDs, steroids, bisphosphonates, Ca antagonists, nitrates, theophyllines, remember OTT

Lifestyle – alcohol, diet, smoking, exercise, weight reduction

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7
Q

what are the protocols for dealing with a patient with dyspepsia

A
  1. ALARMS FEATURES:
    yes - upper GI endoscopy
    no - see 2
  2. AGE
    >55 years - UGIE
    <55 years - test for h pylori
  3. H PYLORI RESULT
    +ve - eradication therapy and symptomatic treatment (PPIs, lifestyle factors)
  4. If symptoms persist - refer to GI
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8
Q

what is helicobactor pylori

A

Gram negative
spiral-shaped, microaerophilic
flagellated bacteria

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9
Q

how does a H pylori infection happen

A

h pylori can colonise gastric mucosa

resides in the surface layer of the mucosa but does not penetrate epithelial layer

instead invokes an immune response in underlying mucosa

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10
Q

what are the 4 different outcomes of h pylori infections

A
  1. asymptomatic or chronic gastritis
  2. chronic atrophic gastritis, intestinal metaplasia
  3. gastric or duodenal ulcer
  4. gastric cancer, MALT lymphoma
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11
Q

what are the outcomes of h pylori infection dependant on

A

site of colonization,

characteristics of bacteria and host factors e.g. genetic susceptibility

other environmental factors e.g. smoking

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12
Q

what does antral predominant gastritis lead to in terms of disease

A

increased acid production

low risk of gastric cancer

= DU disease

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13
Q

what does corpus predominant gastritis lead to in terms of disease

A

decreased acid production

gastric atrophy

= gastric cancer

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14
Q

how can h pylori infection be diagnosed

A

non-invasively

  • serology - IgG against H pylori
  • stool antigen test - ELISA

invasively

  • histology - gastric biopsies stained for the bacteria
  • Culture of gastric biopsies
  • Rapid slide urease test (CLO)
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15
Q

define gastritis

A

Inflammation in the gastric mucosa

Histological diagnosis

Clinical features seen at endoscopy

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16
Q

what are the three types of gastritis (ABC)

A

Autoimmune (parietal cells)
Bacterial (H. pylori)
Chemical (bile/NSAIDs)

17
Q

what can cause peptic ulcers

A

majority - h pylori infection

other - NSAIDS, smoking

rare - crohns, hyperparathyroidism

18
Q

what symptoms are associated with peptic ulcers

A

Epigastric pain is the main feature

Nocturnal/hunger pain

Back pain

Nausea and occasionally vomiting

Weight loss and anorexia

Only sign may be epigastric tenderness

If the ulcer bleeds, patients may present with haematemesis and/or melaena, or anaemia

19
Q

how do you treat a peptic ulcer

A

caused by h pylori - eradication therapy

antacid medication - PPI (omeprazole) or H2 receptor antagonists (ranitidine)

stop NSAIDS

treat complications as they arise

surgery only indicated in complicated PUD

20
Q

what is the eradication therapy for H pylori

A

triple therapy for 7 days:

  1. clarithromycn
  2. amoxycillin (or metronizadole - tetracycline if penicillin allergy)
  3. PPI - omeprazole
21
Q

what are the complications of peptic ulcers

A

Acute bleeding – melaena and haematemesis

Chronic bleeding – iron deficiency anaemia

Perforation

Fibrotic stricture (narrowing)

Gastric outlet obstruction – oedema or stricture

22
Q

how does gastric outlet obstruction present

A

Vomiting – lacks bile, fermented foodstuffs

Early satiety, abdominal distension, weight loss, gastric splash

Dehydration and loss of H+ and Cl- in vomit

23
Q

what will blood results show in gastric outlet obstruction

A

Metabolic alkalosis

Bloods – low Cl, low Na, low K, renal impairment

24
Q

how can gastric outlet obstruction be diagnosed

A

UGIE (prolonged fast/aspiration of gastric contents)

identify cause – stricture, ulcer, cancer

25
Q

how can gastric outlet obstruction be treated

A

endoscopic balloon dilatation

surgery

26
Q

what is the second most common malignancy in the world

A

gastric cancer

27
Q

what are the majority of gastric cancers

A

adenocarcinomas (epithelial cells)

28
Q

how do patients with gastric cancer present

A

Dyspepsia, early satiety, nausea & vomiting, weight loss, GI bleeding, iron deficiency anaemia, gastric outlet obstruction

29
Q

what are some risk factors for gastric cancer

A 
smoking
diet 
H pylori infection
genetic - family history 
previous gastric resection 
biliary reflux
premalignant gastric pathology
30
Q

what are the majority of gastric cancers in terms of genes

A

majority sporadic with no inherited component

<15% familial clustering

1-3% inheritable gastric cancer syndromes - HDGC, AD, CDH-1 gene

31
Q

what enable a histological diagnosis

A

endoscopy and biopsy

32
Q

what staging investigations are carried out for gastric cancer

A

CT chest/abdomen - lymph nodes and liver/lung/peritoneum/bone marrow

33
Q

how is gastric cancer treated

A

MDT discussion of imaging/histology/patient fitness
- Who is present? gastroenterologist, pathologist, radiologist, upper GI surgeons, oncologists, specialist nurses

surgery

chemotherapy

GI (25 decks)

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