Pathologies of the upper GI Flashcards
What is oesophageal reflux?
Reflux of acid from stomach into oesophagus
Causes of oesophageal reflux?
Hiatus hernia is main cause
Development
- Thickening of epithelium
- Can lead to fibrosis/stricture
- Barrett’s oesophagus: metaplasia from squamous to glandular epithelium
Two types of oesophageal cancer and causes
Adenocarcinoma:
- From Barrett’s oesophagus
- Obesity
Squamous cell carcinoma:
- alcohol
- smoking
- diet
Consequences of oesophageal cancer
- Obstruction: occupies lumen and makes swallowing difficult
- Ulceration
- Perforation
- Spread: direct, lymphatic, blood
Gastritis
Inflammation of the stomach
Causes of gastritis- classification
Autoimmune
Bacterial: H.pylori
C: chemical injury (drugs/ smoking)
What is dyspepsia
A series of symptoms which alert a clincian to the presence of an upper GI problem.
Symptoms include a sensation of burning and chest pain.
Can include symptoms such as fullness, belching, bloatedness.
Mild dyspepsia symptoms
Upper abdominal and retrosternal pain
Severe dyspepsia symptoms
- Anorexia/weight loss
- Anemia
- Melena/Haematesis
- Dysphagia
Causes of dyspepsia
Most common: Functional
- Motility disorders
- H.pylori infection
- reflux oesophagi’s
- Psychogenic
Upper GI e.g. gastritis , Duodenitis
Lower GI e.g. IBS
Surrounding organ disorders (Pancreas, gallstones, cardiac disease)
Coeliac disease
Drugs (NSAIDs, aspirin)
How to manage dyspepsia
- Full history and examination
- Blood test
- Drug history
- If ALARM symptoms: endoscopy
- If no ALARM symptoms and over 55: endoscopy
- If no ALARM symptoms and under 55: test for H. Pylori
- If H.pylori test is positive then eradication therapy
Treatment of dyspepsia
- Proton pump inhibitors
- HR2 antagonist
What are ALARM features?
Anorexia Loss of weight Anemia Recent onset when >55 Melena/hematesis Swallowing problems (dysphagia)
Characteristics of H.pylori
- Gram negative bacillus
- Flaggellates
- Digs into superficial gastric mucosa and causes inflammation in the underlying epithelium
Consequences of H.pylori
In 80% of cases: asymptomatic gastritis
In 15-20% of cases: symptomatic gastritis/peptic ulceration
In <1% of cases- gastric cancer
Testing for H.pylori
Invasive:
- Biopsy with staining and culture
- Endoscopy
- Rapid slide test: NH3 from urea
Non-invasive:
- serology
- elisa testing
- 13c/14c urea breath test
What is the 13c/14C urea breath test
Will produce 13c/14c CO2 in breath test as urease produced in break down of urea into ammonia
Treatment for H. Pylori
7 Day treatment of:
- Amoxycillin
- Clarythromycin
- PPI
Type A gastritis
Autoimmune attack against parietal cells
Decreased production of HCl and intrinsic factor
Type B gastritis
H.Pylori releases ammonia- stomach detects a rise in pH - more acid released from parietal cells- inflammation
