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Study Notes - Gastroenterology > *Oesophageal and Stomach disorders 3 (lectures 5 and 6) > Flashcards

*Oesophageal and Stomach disorders 3 (lectures 5 and 6) Flashcards

1
Q

What are the 3 main groups of inflammatory disorders of the stomach?

A

Acute gastritis
Chronic gastritis
Rare

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2
Q

What are the causes of acute gastritis?

A 
Irritant chemical injury
Severe bruns
Shock
Severe trauma
Head injury
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3
Q

What are the causes of chronic gastritis?

A

Autoimmune
Bacterial (H pylori)
Chemical

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4
Q

Rare causes of gastritis? (3)

A

Lymphocytic
Eosinophilic
Granulomatous

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5
Q

What antibodies are related to autoimmune chronic gastritis?

A

Anti-parietal and anti-intrinsic factor antibodies

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6
Q

What will be seen on biopsy of autoimmune chronic gastritis?

A

Atrophy and intestinal metaplasia in body of the stomach

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7
Q

What type of anaemia will patients with autoimmune chronic gastritis have?

A

Pernicious anaemia (due to B12 deficiency)

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8
Q

Do patients with autoimmune chronic gastritis have an increased risk of malignancy?

A

Yes

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9
Q

What conditions do patients with autoimmune gastritis also have?

A 
Pernicious anaemia (B12 deficiency)
Often neurological symptoms
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10
Q

What is the most common type of chronic gastritis?

A

H. pylori associated chronic gastritis

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11
Q

How does H. pylori cause chronic gastritis?

A

It inhabits a niche between the epithelial cell surface and mucous barrier
If not cleared then a chronic active inflammation ensues
IL-8 is critical to this

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12
Q

What produces the anti-H pylori antibodies?

A

Lamina propria plasma cells

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13
Q

What causes chemical chronic gastritis?

A

NSAIDs
Alcohol
Bile reflux
These cause direct injury to mucus layer

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14
Q

What would be seen on biology of chemical chronic gastritis?

A

Marked epithelial regeneration, hyperplasia, contestation and little inflammation
(may produce congestion and little inflammation)

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15
Q

How does increased acid secretion lead to duodenal ulcers?

A

Excess acid in duodenum produces gastric metaplasia and leads to H. pylori infection, inflammation, epithelial damage and ulceration

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16
Q

Why are you more likely to get ulcers in the duodenum compared with the stomach?

A

The duodenum is built for absorption, not protection like the stomach

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17
Q

What 2 factors are important in the development of chronic peptic ulcers?

A

Increased acid production

Failure of mucosal defence

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18
Q

Edges of peptic ulcers?

A

Clear cut - punched out

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19
Q

Wha are the microscopic layers of a peptic ulcer?

A

Floor of necrotic fibrinopurulent debris
Base of inflamed granulation tissue
Deepest layer is fibrotic scar tissue

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20
Q

What type of cancers occur in the stomach?

A

Carcinomas (adencarcinoma)
Lymphomas
Gastrointestinal stromal tumours

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21
Q

What are 4 other premalignant conditions of the stomach, other than H pylori?

A

pernicious anaemia
Partial gastrectomy
HNPCC/ lynch syndrome
Menetrier’s disease (large folds in stomach)

22
Q

What are the 2 subtypes of gastric adenocarcinoma?

A

Intestinal type - exophytic/ polypoid mass (easier to treat)
Diffuse type - expands/ infiltrates stomach wall
15% are mixed

23
Q

Are gastric ulcers potentially malignant?

24
Q

What is a Kruckenberg tumour?

A

malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast.[1] Gastric adenocarcinoma, especially at the pylorus, is the most common source

25
Q

What type of gastric lymphoma do patients get?

A

Mucosa associated lymphoid tissue (MALT)

26
Q

What is MALT gastric lymphoma associated with?

A

H pylori - continuous inflammation induces an evolution into a clonal B-cell proliferation

27
Q

What happens if you treat H pylori in patients with MALT?

A

It regresses 95% of the time

28
Q

What are the most common causes of upper GI bleeding?

A 
Duodenal ucer
Gastric erosions
Gastric ulcer
Varices
Mallory-weiss tear
oesophagitis
erosive duodenitis
Neoplasm
Stomal ulcer
Oesophageal ulcer
29
Q

What is the most important initial treatment of a patient with an upper GI bleed?

A

Resuscitation (A, B, C) - O2, IV access, fluids

Prompt endoscopy

30
Q

What is the “100 rule” for poor prognosis with a haemorrhage?

A 
Systolic BP less than 100mmHg
Pulse less than 100/min
Hb less than 100g/L
Age greater than 60
Comorbid disease
Postural drop in blood pressure
(be cautious of young people, diabetics and patients on beta blockers)
31
Q

What is another name for an OGD?

32
Q

What is the purpose of performing an endoscopy in a patient with an upper GI bleed? (3)

A

To identify cause
Therapeutic manoeuvres
Assess risk of rebleeding

33
Q

What scoring system is used to assess the mortality of a patient with an upper GI bleed?

A

Rockall risk scoring sustem

34
Q

What is a screening tool to assess the likelihood that a patient with an acute upper gastrointestinal bleeding (UGIB) will need to have medical intervention such as a blood transfusion or endoscopic intervention?

A

The Blatchford score

35
Q

Management of GI bleed if blatchford score of 0-1 (low risk)?

A

If no clinical concerns, the patient can be discharged without an endoscopy

36
Q

Management of GI bleed if blatchford score of 2-5 (indeterminate risk)?

A

Monitor Hb
If witnessed significant bleeding or stigmata consider IV omeprazole
If stigmata of cirrhosis/ known liver disease give telipressin
Reassess to determine need for endoscopy

37
Q

Management of GI bleed if blatchford score is greater than 6?

A 
Repeat Hb at regular intervals
Give transfusion if needed
IV omeprazole if witnessed bleeding or stimgmata
If cirrhosis, give telipressin
Reverse any coagulopathy
Endscopy
38
Q

Treatment of bleeding peptic ulcer?

A

Endoscopic treatment (high risk ulcers)
Acid suppression?
Surgery
H pylori eradication

39
Q

Possible endoscopic treatment of a bleeding peptic ulcer? (5)

A 
injection
heater probe coagulation
Combinations
Clips
Haemospray
40
Q

What can be injected into a bleeding ulcer to stop it bleeding?

A

Adrenaline

41
Q

How does haemospray work?

A

When it comes in contact with blood, powder absorbs water then acts both cohesively and adhesively forming a mechanical barrier over the bleeding site

42
Q

What does giving an infusion of omeprazole do when a patient has a bleeding ulcer?

A

Reduces chance of re-bleed and death

43
Q

Treatment of peptic ulcer after endoscopy stops bleeding?

A

Omeprazole IV

H pylori eradication

44
Q

Treatment of bleeding peptic ulcer if not able to be stopped by endoscopy?

45
Q

Risk factors for varies bleeding?

A

Portal pressure greater than 1mmHg
Varies greater than 25% of oesophageal lame
Presence of red signs
Degree of liver failure

46
Q

When should you suspect that an upper GI bleed is caused by varices?

A

Known history of cirrhosis with varies
History of chronic alcohol excess, chronic viral hepatitis, metabolic or autoimmune liver disease, intra-abdominal sepsis/ surgery
Stigmata of chronic liver disease

47
Q

Achievement of haemostasis in patients with varcies? (5)

A 
Telipressin (vasopressin analogue)
Endoscopic variceal ligation (banding)
Sclerotherapy
Sengstaken-Blakemore balloon
TIPS
48
Q

How is vasopressin given?

A

Bolus 1-2mg 4 hrly

49
Q

What is sclerotherapy?

A

an injection of a solution (generally a salt solution) directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot.

50
Q

What is the sengstaken-blakemore tube?

A

Tube with balloon that is used when endoscopic haemostasis fails
Left in patient for 24 hours and puts pressure on bleeding varices

51
Q

What does TIPS involve?

A

Joining of portal vein and hepatic vein

Study Notes - Gastroenterology (42 decks)

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