Lecture 12 Upper GI disease Flashcards
Define chronic gastritis
Ongoing inflammation of the stomach mucosa. Symptoms less severe than acute gastritis.
What can arise from chronic gastritis?
Dysplasia and carcinoma
What are the symptoms of chronic gastritis?
Upper abdo pain. Indigestion/ bloating. N/V. Belching. Loss of appetite/weight loss.
Can chronic gastritis be asymptomatic?
yes
What can cause chronic gastritis?
ABC and other.
Autoimmune, bacterial, Chemical and other.
What can autoimmune problems (chronic gastritis) lead?
Pernicious anameia
What causes bacterial infection in stomach?
Helicobacter pylori infection
Notes on helicobacter pylori infection
Gram-neg bacteriain stomach, particularly antrum, infects over half the worlds population. Faecal-oral route. Untreated -> infection persists throughout life.
H.pylori is linked to what development?
Duodenal ulcers and stomach ulcers
What is the clinical presentation H.pylori.
80% asymptomatic. 5-15% peptic ulcer disease. 10% non-ulcer dyspepsia. 1-3% gastric adenocarcinoma.
What are the effects of h.pylori infections predominantly in body of stomach.
Gastric cancer
Hypochlorhydria
Gastric atrophy
Intestinal metaplasia
What are the effects of h.pylori infections predominantly in antrum.
Duodenal ulcers
Hyperchlorhydria
What chemicals can cause chronic gastritis?
Alcohol, tobacco and caffeine
What else (apart from ABC) can cause chronic gastritis?
Psychological stress
Where does peptic ulcer disease usually occur?
D1 or antrum (4:1)
What can cause peptic ulcer disease?
H. pylori (80-100% DU and 65% gastric). NSAIDs
When are peptic ulcers worse?
at night and after meals
What are the symptoms of peptic ulcer disease?
Pain (gnawing, burning and aching)
What are complications of peptic ulcer disease?
Bleeding -> iron deficiency anaemia. Massive haematemesis. Performation -> peritonitis. Long term cancer at edge of ulcer
What is Barrett’s Oesophagus?
When lining of oesophagus changes from stratified squamous epithelium to columnar epithelium with goblet cells
Where is columnar epithelium and goblet cells normally found?
low in GIT
What is Barrett’s Oesophagus dysplasia process?
Low grade to high grade to invasive carcinoma.
Where can oesophageal carcinoma be spread (haematogenous) to?
Liver or lung
Who can suffer from oesophagus squamous cell carcinoma?
Adults over 45. M:F 4:1
What are the survival rates for oesophagus squamous cell carcinoma?
5 year survival of 9%
What are the risk factors for Oesophagus sqaumous cell carcinoma?
Alcohol, tobacco, caustic injury, achalasia
Define achalasia?
when the lower part of the oesophagus fails to relax, preventing food passing to stomach
What are the symptoms of Oesophageal carcinoma?
Dysphagia, weight loss, haemorrhage, sepsis, resp fistula, aspiration.
What are the symptoms of Barrett’s Oesophagus?
Dysphagia, weight loss, haematemesis, chest pain, vomiting
What are the gender statistics for Barrett’s Oesophagus?
M:F 7:1
What is the survival rate for Barrett’s?
5 year survival
What accounts for 90% of gastric malignances?
Adenocarcinoma
What are the precursor lesions for stomach adrenocarcinoma?
Pernicious anaemia, intestinal metaplasia, neoplastic polyps, Helicobacter gastritis.
What is the 2nd most common carcinoma world wide?
Stomach adrenocarcinoma
What are the early symptoms of stomach adenocarcinoma?
Same as gastritis
What are the advanced stomach adenocarcinoma symptoms?
Weight loss, anorexia, anaemia, haemorrhage, fungating exophytic growth.
What is the survival rates for stomach adenocarcinoma?
5 year survival (early) after surgery 90%!!!
Overall 5 year survival 30%
Where can stomach cancer directly spread to?
Duodenum, pancreas, colon, liver, spleen.
Define virchow’s node?
Lymph node in left supraclavicular fossa. Takes blood supply from abdominal cavity
Where can stomach cancers spread to through haematogenous?
Liver and lungs
Small bowel neoplasia is
small chance. relatively rate compared to other GI mlignancies
What are risk factors for small bowel adenocarcinoma?
Crohn’s disease and Coeliac disease, radiation, hereditary.
Define Coeliac disease?
Extensive mucosal disease related to gluten sensitivity. Immune mediated villous atrophy and malabsorption
How can Coeliac disease by diagnosed?
Serological blood test and biopsy
What are the symptoms of coeliac disease?
Pain in digestive tract, chronic constipation and diarrhoea, failure to thrive (children), anaemia, fatigue.
What can coeliac disease increase the risk of?
adenocarcinoma and lymphoma of small bowel
