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Alimentary System > Lecture 16 Helicobacter pylori and Gastric Disease > Flashcards

Lecture 16 Helicobacter pylori and Gastric Disease Flashcards

1
Q

What is Dyspepsia

A

A group of symptoms that include Pain or discomfort in the upper abdomen, upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn that last for 4 weeks

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2
Q

Symptoms of Dyspepsia

A
  • Epigastric pain
  • Burning
  • Fullness
  • Bloating
  • Satiety
  • Nausea
  • Sickness
  • Heartburn
  • Reflux
  • Discomfort
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3
Q

If a patient presents with dyspepsia what are the necessary investigations

A

History and examination
Bloods
Drug history
Lifestyle

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4
Q

When do you refer someone that has presented with dyspepsia to endoscopy

A

ALARMS- suspicion of malignancy

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5
Q

What is H.pylori

A

Gram negative
Spiral shaped
Microaerophilic flagellated

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6
Q

Describe the pathogenesis of H.pylori

A

Enters host and survival
Motility and chemotaxis
Adhesion-receptor interaction-establish colonisation
Toxins release- damage host

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7
Q

What are the 3 divergent responses to H.pylori infection

A

Antral predominant gastritis
Mild mixed gastritis
Corpus predominant gastritis

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8
Q

Describe astral predominant gastritis

A

Increase in acid
Low risk of gastric cancer
Can develop into DU disease

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9
Q

Describe Mild mixed gastritis

A

Normal acid

No significant disease

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10
Q

Describe Corpus predominant gastritis

A

Decrease in acid
Gastric atrophy
Increase risk of developing into gastric cancer

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11
Q

How is a H.pylori infection diagnosed

A 
Serology- IgG against H.pylori
13C /14C Urea Breath Test
Stool antigen test- ELISA
Histology- bx
Rapid slide urease test
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12
Q

What is gastritis

A

Inflammation in the gastric mucosa

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13
Q

What are the 3 types of gastric mucosa

A
  • Autoimmune (parietal cells)
  • Bacterial (H. pylori)
  • Chemical (bile/NSAIDs)
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14
Q

What are the complications of gastritis

A

Peptic ulcers

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15
Q

What are the common causes of peptic ulcers

A 
H.pylori infections
NSAIDS
Smoking
Zollinger-Ellison syndrome
Hyperthyroidism
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16
Q

What are the symptoms of peptic ulcers

A 
Epigastric pain
Nocturnal/hunger pain
Back pain
Nausea, occasional vomiting
Weight loss
Anorexia
Epigastric tenderness
Haematamesis 
Melaena
Anaemia
17
Q

Treatment of Peptic ulcers

A

if causes by H.pylori- eradication therapy

Antacid-proton pump inhibitors (omeprazole) or H2 receptor antagonists (ranitidine)

18
Q

Describe Eradication Therapy

A

• Triple therapy for 7 days
• Clarithromycin 500mg bd
• Amoxycillin 1g bd (or Metronidazole 400mg bd)
• Tetracycline is given if penicillin allergy
PPI- omeprazole

19
Q

Why is triple therapy important

A

To prevent resistance

20
Q

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
21
Q

Presentation of gastric outlet obstruction

A 
Vomiting
Early satiety
Abdominal distention
Weight loss
Gastric splash
22
Q

Signs of gastric outlet obstruction

A
  • Dehydration and loss of H+ and Cl- in vomit
  • Metabolic alkalosis
  • Bloods – low Cl, low Na, low K, renal impairment
23
Q

How is gastric outlet obstruction diagnosed

A

• UGIE (prolonged fast/aspiration of gastric contents), identify cause – stricture, ulcer, cancer

24
Q

What is the treatment for gastric outlet obstruction

A
  • Endoscopic Balloon dilatation

* Surgery

25
Q

Whats the most common type of gastric cancer

A

Adenocarcinoma

26
Q

What are the presentation of gastric cancer

A
  • Dyspepsia
  • Early satiety
  • Nausea and vomiting
  • Weight loss
  • GI bleeding
  • Iron deficiency anaemia
  • Gastric outlet obstruction
27
Q

Aetiology of Gastric Cancer

A
  • Diet
  • Genetics
  • Smoking
  • Previous gastric resection
  • Biliary reflux
  • Premalignant gastric pathology
28
Q

What genes are associated with gastric cancer

A

HDGC; AD, CDH-1 gene (E-cadherin)

• 1-3% heritable gastric cancer syndromes

29
Q

Management of gastric cancer

A
  • Endoscopy and biopsies to make a histological diagnosis
  • Staging investigations – has it spread elsewhere?
  • CT chest/abdo – lymph nodes and liver/lungs/peritoneum/bone marrow
  • MDT discussion – imaging/histology/patient fitness
30
Q

Treatment of gastric cancer

A

Surgical and chemotherapy

Alimentary System (39 decks)

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