Pathophysiology Of Gastric Disease

Question 1

What is Zollinger-Ellison syndrome?

Answer 1

Very rare
Gastrin secreting tumour of the pancreas
Acid production increased
Nasty erosions

Question 2

Define GORD and symptoms

Answer 2

Gastro-oesophageal reflux disease
Reflux of stomach contents
Damages mucosa
Sx = heartburn, cough, sore throat, dysphagia

Question 3

Why might GORD cause dysphagia?

Answer 3

Strictures formed in the oesophagus due to the damage to the mucosa

Question 4

What are some causes of GORD?

Answer 4

Lower oesophageal sphincter problems
Delayed gastric emptying (often in diabetes)
Hiatus hernia
Obesity (increased abdo pressure)

Question 5

Describe a hiatus hernia

Answer 5

LOS problem
Stomach herniates through into thorax
Easier to reflux

Question 6

What metaplasia occurs in Barrett’s oesophagus?

Answer 6

Stratified squamous to simple columnar

Question 7

What are the treatments for GORD?

Answer 7

Life style modifications (diet, smaller meals)
Pharmacological - antacids, PPIs, H2 antagonists
Surgery (rare)

Question 8

Describe what happens in acute gastritis and some of the causes

Answer 8

Inflammation of the mucosal lining
< few weeks
Due to: heavy use of NSAIDs, lots of alcohol, chemotherapy or bile reflux
(Things that break down the normal protective mechanisms)

Question 9

How can chemotherapy lead to acute gastritis?

Answer 9

Decrease the turnover rate of cells

Cannot shed stomach lining as quickly

Question 10

What are the Sx of acute gastritis?

Answer 10

Pain
Nausea
Vomiting
(Occasionally bleeding)

Question 11

What are the common causes of chronic gastritis?

Answer 11

Bacterial - H. Pylori infection (most common)
Autoimmune - antibodies to parietal cells
Chemical/reactive - chronic alcohol abuse, NSAIDs, bile reflux

Question 12

How can autoimmune causes of gastritis lead to pernicious anaemia?

Answer 12

Damage to parietal cells
Intrinsic factor not released
Cannot absorb vit B12
Vit B12 deficiency -> pernicious anaemia

Question 13

What are the Sx of H. Pylori causing chronic gastritis?

Answer 13

Asymptomatic or similar to acute gastritis

Sx may develop due to complications

Question 14

What are the Sx of an autoimmune chronic gastritis?

Answer 14

Anaemia
Glossitis (inflammation of tongue)
Anorexia (decreased appetite)
Neurological Sx

Question 15

To be classed as an ulceration, which layer must it extend through?

Answer 15

Muscularis mucosa

Question 16

Where is the most common place to get a peptic ulcer?

Answer 16

1st part of the duodenum

Question 17

Why is the 1st part of the duodenum exposed to ulcers?

Answer 17

Very acidic chyme coming out of the stomach

Often not neutralised fast enough

Question 18

Describe the problems with the physiology that can lead to ulcers

Answer 18

Decreased mucus
Decreased HCO3- 
Decreased blood flow
Decreased prostaglandins
Decreased epithelial renewal

Question 19

Describe the common Sx of peptic ulcers

Answer 19

Epigastric pain (foregut)
Burning/gnawing pain
Follows meal times (worse with acid release)
Often at night (esp duodenal)

Question 20

Describe the Sx of a very serious peptic ulcer

Answer 20

Normal Sx plus:
Bleeding - vomiting
Anaemia 
Satiety 
Weight loss

Question 21

What is functional dyspepsia?

Answer 21

Having symptoms of ulcer disease with no physical evidence of the disease
Common
Diagnosis of exclusion

Question 22

How do we diagnose gastric pathologies?

Answer 22

Upper GI endoscopy 
Biopsy - benign/malignant 
Urease breath test - H. Pylori 
Erect chest x-ray - perforations 
Blood test - anaemia

Question 23

How does H. Pylori survive the harsh environment of the stomach?

Answer 23

Uses urease to breakdown urea into ammonia

Creates a cloud of increased pH around itself to protect from the acid conditions

Question 24

How do we eradicate H. Pylori?

Answer 24

Triple therapy

PPI + clarithomycin + amoxicillin

Question 25

How is H. Pylori spread?

Answer 25

Oral-oral

Faecal-oral

Question 26

Describe some features of H.pylori

Answer 26

Helix shaped
Gram negative
Aerobic (only needs a small amount)
Produces urease 
Flagellum - good motility

Question 27

What are the problems with having H.pylori present in the stomach?

Answer 27

Release of cytotoxins - direct epithelial injury
Express enzymes - ammonia is toxic to epithelia
Possible degrades mucus layer
Promotes inflammatory response - self injury
(Breakdown of the protective barrier)

Question 28

Where is the majority of H.pylori colonisation?

Answer 28

Antrum (and body)

Question 29

To cause a stomach ulcer, H.pylori would commonly colonise where?

Answer 29

Body

Question 30

What problems can occur as a result of Zollinger-Ellison syndrome?

Answer 30

Proliferation of parietal cells - increased acid
Severe ulceration of stomach/small bowel
Abdominal pain
Diarrhoea

Question 31

Stress ulceration of the stomach give occur following these massive physiological stresses:

Answer 31

Severe burns 
Increased intracranial pressure
Sepsis
Severe trauma 
Multiple organ failure

Question 32

How common is stomach cancer?

Answer 32

3rd most common cancer in the world

Question 33

Name some Sx that can occur with stomach cancer

Answer 33

Dysphagia 
Loss of appetite
Malaena
Weight loss
Nausea/vomiting
Virchow's nodes

Question 34

Give some major risk factors for getting stomach cancer

Answer 34

Male
H.pylori
Diet (high salt)
Smoking

Question 35

What are the 2 types of adenocarcinoma?

Answer 35

Intestinal

Diffuse

Question 36

What do we do to diagnose stomach cancer?

Answer 36

Bloods
Upper GI endoscopy - visualise and biopsy
CT scan - staging