L9 pathophysiol gastric dis

Question 1

LO2: desc present, investig and managem comm gastric disords.

Answer 1

GORD:
- refl stom cont to oesoph. LOS dysfunc- less musc than pyloric, uses angle, some musc, R crus diaph wrap when incr press.
- symps- heartb, cuogh/wheeze, sore throat, dysphag.
-causes- LOS prob.
delay gastric emp= incr press.
hiatus hernia- LOS through top diaph to thorax, press diffs allow reflux.
obesity.
-probs- oesoph not protec from chem, squam epith.
oesophagitis.
fib strictures= narr luman dysphag and sol regurg.
barretts metaplasia squam to col, 30/40x adenocarcinoma.
-tx- lifest eg small meals, not bef bed, sleep upr.
pharm- antacids, H2 antag, PPI.
surg rare.

Question 2

LO2

Answer 2

ACUTE GASTRITIS:
transient. breach in defs. can be part or whole.
-acute mucosal inflamm proc-
lot NSAIDs decr prostaglandin synth. lot alc. chemo.
bile reflux uncomm- bile to duod, can get refl rev paristal- duod cont to stom. bile v irrit.
-symps- comm asymp.
pain, naus, vom.
occ bleed, poss fatal. large sa, hyperaemic, red, inflamm.
lymphoc and polymorphs invade, lot inflamm cells surr gastric pits.
-tx- rem insult.

Question 3

LO2

Answer 3

CHRONIC GASTRITIS:
bact- H pylori most comm cause.
autoimm- Ab to gastric pariet, can= pernic anaem. IF essen for abs vit B12. defic= megalob anaem.
chem/reactive (min inflamm)- not maj cause. alc abuse. LT NSAIDs. refl bile.
-symps-
H pylori- asymp or sim to acute. may dev due to complics eg ulcer, adenocarcinoma, MALT lymphoma.
autoimm- symps of anaem. glossitis. anorexia. neuro symps assoc vitB12 defic eg vis disturb, coord/gait prob, numb, ting.

Question 4

LO3: desc clinic feats and nat hx ulcer dis.

Answer 4

PEP ULCER:
comm dyspep. defec gastric/duod mucosa. must x MM. most comm in 1st part duod. comm aff lesser curve, somet bod.
norm def mechs and epith breached eg mucus, bicarb. prostagl stim muc blood flow allows rem ac that diff through inj mucosa. epith renew high t/o.
chronic= recurr. will heal or furth conseqs.
-cause- muc inj- stom ac. H pylori. NSAIDs. smoking only cause relapse. only massive phys stress eg burn or trauma.
-symps- poss no pain. epigastric and somet back pain. burn/gnaw after meal. often at night esp duod.
serious- bleed/anaem. if perfor bowel= cont to perit cav= pain and inflamm= peritonitis. can erode into art eg gastroduod beh 1st part duod. hemotemesis. GIT try metab blood= melaena.
early satiety= weight loss.
- func dyspep- have symps ulcer dis but np phys ev organic dis. diag of exclusion only.

Question 5

LO2: diag of gastric pathol.

Answer 5

• upper GI endosc- stom and 1st part duod. allow biopsies- benign/malig ulcerat, H pylori.
• urease breath test- H pylori prods urease= break up urea to nh3. small radiplab urea, if lab C in co2 then was brok down in stom by H pylori.
• erect chest x ray- for perforat. show gas in perit cav- gap btw diaph and liv/stom.
• blood test for anaem.

Question 6

LO4: outl princips of mod ulcer tx.

how gastric ac sec decr by drugs.

Answer 6

• erad H pylori- triple therap- PPI, clarithromycin, amoxycillin.
• stop NSAIDs.
• endosc for bleed ulcer, and foll up for treated ulcers. injec arnd ulcer= seal.
• PPIs- eg omeprazole. more eff.
• H2 blockers- cimetidine/ranitidine. block histamine from ECL.

Question 7

LO5: expl imp of H pylori in cause chronic gastritis and modif gastric physiol.

Answer 7

-oral/oral or fecal/oral. helical gram neg microaerophillic.
-prod urease- conv urea to nh3. incr loc pH= protec.
-has flag- chemotaxis to high pH. lives in muc lay, adhere gastric epith.
-probs- rel cytotox= dir epith inj. nh3 tox. poss deg mucus lay. prom inflamm resp and self inj. most asymp.
-colonisat locat- diff effs as diff cells. fundus and cardia muc sec. bod pariet prod ac and IF, chief sec pepsinogen. antrum sec gastrin activs ac.
if colon antrum= incr gastrin sec or decr D cell activ. incr pariet ac sec. duod epith metap- colon duod as more ac and alt cells, duod ulcerat.
if antrum and bod- asymp- wide distrib cancels.
if predom bod- atrophic eff pariet- gastric ulcer, int metaplasia and dysplasia if left= incr CA.

Question 8

LO2

Answer 8

ZOLLINGER ELLISON SYND:
non beta islet cell gastrin sec tum of panc. can be part of MEN1 neoplasia. prolif pariet= incr ac, sev ulcerat stom and small bowel= abdo pain, diarr as poor abs.

Question 9

LO2

Answer 9

STRESS ULCERAT:

symps of gastritis/ulcerat foll- sev burns, incr intracranial press, sepsis, sev trauma, multip organ fail.

Question 10

LO2

Answer 10

STOM CA:
3rd comm CA world. less W dev as refrig not salt.
us late present, need large= symp.
- symps- dysphag near cardia blocks. decr appet. malaena if eros. weight loss as decr appet and metab intens. naus/vom. virchow nodes-LN L supraclavic reg.
- lot in chile/japan/SA- have screen.
-RFs- male, H pylori, diet salt and fat, smok.
-maj are adenocarcinoma- intestinal, diffuse. less lymphoma, carcinoid, stromal.
-diag- bloods anaem. upp GI endosc for vis and biop. CT for spread.
-tx- surg/chemo/rad. lot palliative. endosc muc resection if v early CA eg where screening.

Question 11

LO1: desc prev and incid comm disord aff stom.

Answer 11

• p to 40% ad dyspep ev yr= upper GI symps.
• 7000 new stom CA per yr UK.
• stom dis centre arnd inflamm, metaplasia, dysplasia.