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ESA 3 - Gastrointestinal System > Pathophysiology Of Gastric Disease > Flashcards

Pathophysiology Of Gastric Disease Flashcards

1
Q

What is dyspepsia?

A

A complex of upper GI symptoms which are typically present for four to more weeks including upper abdominal pain or discomfort, heartburn, acid reflux, nausea / vomiting.

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2
Q

What are some common gastric disorders?

A

GORD

Gastritis -acute or chronic (bacterial or autoimmune)

Peptic ulcer disease

Zollinger-Ellison disease

Cancer of the stomach

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3
Q

What are the symptoms of GORD?

A

Chest pain, acid taste in mouth, cough

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4
Q

What are the consequences of GORD?

A

Nothing
Oesophagus
Strictures (benign)
Barrett’s oesophagus (metaplasia of squamous cell in oesophagus to gastric type - can predispose to adenocarcinima)

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5
Q

What does the lower oesophageal sphincter consist of?

A

Muscular element
Right crus of diaphragm (T10)
Angle of entry of oesophagus into stomach
Intra-abdominal pressure

LOS = last 4cm of oesophagus

Resting pressures between 10-30mmHg (only 5-10 needed) - at rest it is tonically contrasted.

Pressures vary -lowest after meals and highest at night.

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6
Q

How do you treat GORD?

A

Lifestyle modification (avoid foods / reduce intraabdominal pressure - loose weight)

Pharmacological

  • Antacids
  • H2 antagonists
  • PPIs

Surgery -Fundoplication (wrap distal oesophagus round fungus of stomach)

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7
Q

Why is reflux more common in people with hiatus hernias?

A

Unclear BUT:

Reduces basal tone
Reduces the normal increase in LOS tone when straining.

-loose angle, stretch ligaments and just simply weaken the stomach.

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8
Q

What is gastritis?

A

Difficult to define:

  • Symptom complex (pain,nausea, vomiting, bleeding)
  • Endoscopic appearance
  • Inflammation of the stomach mucosa

There are acute and chronic varieties.

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9
Q

What can cause acute gastritis?

A

Heavy use of NSAIDS (reduce prostaglandin synthesis - so less mucosal blood flow).

Lots of alcohol

Chemotherapy

Bile reflux

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10
Q

What is acute gastritis?

A

This is when the exposure of the mucosa to chemical injury results in damaged epithelial cells and a reduction in mucus production.

Mucosa responds by vasodilation / oedema and appearance of inflammatory cells (neutrophils)

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11
Q

What are the symptoms and treatment of acute gastritis?

A

Symptoms:

  • Asymptomatic
  • Abdominal pain , nausea, vomiting
  • Occasionally bleeding (which can be fatal)

Treat by removing the irritant.

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12
Q

What are the causes of chronic gastritis?

A

Acute causes used for a long time (alcohol, NSAIDS, bile)

Bacterial - H.-pylori (most common)

Autoimmune -antibodies to gastric parietal cells can lead to pernicious anaemia.

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13
Q

What are the symptoms of chronic gastritis cause by H-pylori?

A

Asymptomatic or similar to acute gastritis

Symptoms may develop due to complications:
-peptic ulcers, adenocarcinimas. MALT lymphoma

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14
Q

What are the symptoms of chronic gastritis cause by autoimmune?

A

Gastro symptoms as well as:

Symptoms of anaemia
Glossitis
Anorexia
Neurological symptoms

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15
Q

Describe the characteristics of H. Pylori

A

Helix shaped, gram,m negatice, microaeophilic (would be toxic if normal oxygen)

Spread oral to oral/faecal to oral

Produces urease - converts urea to ammonium (basic in solution) and increases local pH/

Has a flagellum so good motility - lives in mucus layer and adheres to gastric epithelia.

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16
Q

Why is H.Pylori a problem?

A

Release cytotoxins - Direct epithelial injury

Expresses enzymes - unease which converts are to ammonium and ammonia is toxic to epithelia

It possibly degrades the mucus layer

Promotes inflammatory response - self injury.

17
Q

Where in the stomach would H.Pylori colonise to become symptomatic?

A

Just in the Antrum of the stomach (home of G cells) or just in the body

Asymptomatic if in atrium and body

18
Q

What are the symptoms of H. Pylori in the antrum of the stomach?

A

Increased Gastrin secretion (or decreased D cell activity)

Increased parietal cell acid secretion.

  • Duodenal epithelial metaplasia
  • Colonisation of duodenum
  • Duodenal ulceration
19
Q

What are the symptom of H. Pylori in the body of the stomach?

A

Atrophic effect
Gastric ulcer
Leads to intestinal metaplasia which leads to dysplasia and cancer.

20
Q

How do you diagnose H. Pylori?

A

Urea breath test (C13)

Stool antigen test

Blood test

21
Q

How do you treat H. Pylori?

A

PPIs

Amoxicillin + clarithromycin and metronidazole

22
Q

What is a peptic ulcer?

A

Defect in gastric / duodenal mucosa that expends through muscularis mucosa.

Most common in first part of stomach

Commonly affects lesser curve / antrum of stomach.

23
Q

What are the normal defence mechanisms against peptic ulcer disease?

A

Mucus

Bicarbonate

Adequate mucosal blood flow -can remove acid that diffuses through injured mucosa.

Prostaglandins

Epithelial renewal

24
Q

What happens if defences break down?

A

Breakdown of normal defences is more important than excessive acid.

Ulcers develop - if normal / low acid.

Rapid gastric emptying / inadequate acid neutratilation (from bile / pancreas) has been implicated in duodenal ulcers.

25
Q

What are some causes of peptic ulcer disease?

A 
Stomach acid 
H. Pylori 
NSAIDS
Smoking (relapse)
Stress -only massive physiological stress like burns.
26
Q

What does peptic ulcer disease look like (morphology)?

A

Less than 2cm in diameter
Base of ulcer is necrotic tissue / granulation tissue
Muscularis propria can be replaced by scar tissue.

27
Q

What are the clinical consequences of peptic ulcer disease?

A

Scar tissue shrinking can narrow stomach lumen or cause pyloric stenosis

Perforation causing peritonitis

Erosion into adjacent structures (liver / pancreas)

Haemorrhage from vessel in base of ulcer

Malignancy (rare)

28
Q

What are the symptoms of peptic ulcer disease?

A

Epigastic pain (sometimes back pain)

  • Burning / gnawing
  • Follows meal times
  • Often at night (especially DU)

Serious:

Bleeding / anaemia (haematemesis (vomit blood) or malaena (black / tar stool)

Satiety (early)

Weight loss

You will experience pain from gastric ulcers sooner after eating than you would with duodenal ulcers (generally..)

29
Q

How do you manage peptic ulcer disease?

A

Lifestyle modification

Stop any exacerbating medications

Test H.Pylori

PPIs

Endoscopy

30
Q

What is functional dyspepsia?

A

Have symptoms of ulcer disease but no physical evidence or organic disease.

It is a diagnosis of exclusion.

31
Q

How do you diagnose gastric pathology?

A

Upper GI endoscopy

Biopsy - benign / malignant ulceration or H. Pylori

Erect chest X-ray - performation (look for pneuroperitoneum)

Blood test - anaemia

32
Q

Give example of H2 blockers

A

Cimetidine

Ranitidine

33
Q

Give examples of PPIs

A

Omeprazole

Landsoprazole

34
Q

What is Zollinger-Ellison syndrome?

A

Non-beta islet cell gastrin secreting tumour of the pancreas.

Proliferation of parietal cells:

  • Lots of acid production
  • Severe ulceration of the stomach and small bowel causing abdominal pain and diarrhoea.
35
Q

What can cause stress ulceration?

A 
Severe burns 
Raised ICP
Sepsis 
Severe burns 
Multiple organ failure
36
Q

How does stomach cancer present?

A

Has tube large before symptoms:

  • Dysphagia
  • Loss of appetite
  • Malaena
  • Weight loss
  • Nausea / vomitting
  • Virchows nodes (enlarged lymph node)
37
Q

What are some risk factors for stomach cancer?

A

Male
H. Pylori
Dietary factors
Smoking

ESA 3 - Gastrointestinal System (18 decks)

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