Difficult to define: - Symptom complex (pain,nausea, vomiting, bleeding) - Endoscopic appearance - Inflammation of the stomach mucosa There are acute and chronic varieties.

Pathophysiology Of Gastric Disease Flashcards by Sophie Wakeling

What is dyspepsia?

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.

How well did you know this?

Not at all

Perfectly

What are some common gastric disorders?

GORD

Gastritis -acute or chronic (bacterial or autoimmune)

Peptic ulcer disease

Zollinger-Ellison disease

Cancer of the stomach

How well did you know this?

Not at all

Perfectly

What are the symptoms of GORD?

Chest pain, acid taste in mouth, cough

How well did you know this?

Not at all

Perfectly

What are the consequences of GORD?

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

How well did you know this?

Not at all

Perfectly

What does the lower oesophageal sphincter consist of?

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.

How well did you know this?

Not at all

Perfectly

How do you treat GORD?

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

Pharmacological

Antacids
H2 antagonists
PPIs

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

How well did you know this?

Not at all

Perfectly

Why is reflux more common in people with hiatus hernias?

Unclear BUT:

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

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

How well did you know this?

Not at all

Perfectly

What is gastritis?

Difficult to define:

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

There are acute and chronic varieties.

How well did you know this?

Not at all

Perfectly

What can cause acute gastritis?

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

Lots of alcohol

Chemotherapy

Bile reflux

How well did you know this?

Not at all

Perfectly

What is acute gastritis?

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)

How well did you know this?

Not at all

Perfectly

What are the symptoms and treatment of acute gastritis?

Symptoms:

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

Treat by removing the irritant.

How well did you know this?

Not at all

Perfectly

What are the causes of chronic gastritis?

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.

How well did you know this?

Not at all

Perfectly

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

Asymptomatic or similar to acute gastritis

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

How well did you know this?

Not at all

Perfectly

What are the symptoms of chronic gastritis cause by autoimmune?

Gastro symptoms as well as:

Symptoms of anaemia
Glossitis
Anorexia
Neurological symptoms

How well did you know this?

Not at all

Perfectly

Describe the characteristics of H. Pylori

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.

How well did you know this?

Not at all

Perfectly

Why is H.Pylori a problem?

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.

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

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

Asymptomatic if in atrium and body

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

Increased Gastrin secretion (or decreased D cell activity)

Increased parietal cell acid secretion.

Duodenal epithelial metaplasia
Colonisation of duodenum
Duodenal ulceration

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

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

How do you diagnose H. Pylori?

Urea breath test (C13)

Stool antigen test

Blood test

How do you treat H. Pylori?

PPIs

Amoxicillin + clarithromycin and metronidazole

What is a peptic ulcer?

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

Most common in first part of stomach

Commonly affects lesser curve / antrum of stomach.

What are the normal defence mechanisms against peptic ulcer disease?

Mucus

Bicarbonate

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

Prostaglandins

Epithelial renewal

What happens if defences break down?

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.

What are some causes of peptic ulcer disease?

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

What does peptic ulcer disease look like (morphology)?

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

What are the clinical consequences of peptic ulcer disease?

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)

What are the symptoms of peptic ulcer disease?

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..)

How do you manage peptic ulcer disease?

Lifestyle modification Stop any exacerbating medications Test H.Pylori PPIs Endoscopy

What is functional dyspepsia?

Have symptoms of ulcer disease but no physical evidence or organic disease. It is a diagnosis of exclusion.

How do you diagnose gastric pathology?

Upper GI endoscopy Biopsy - benign / malignant ulceration or H. Pylori Erect chest X-ray - performation (look for pneuroperitoneum) Blood test - anaemia

Give example of H2 blockers

Cimetidine | Ranitidine

Give examples of PPIs

Omeprazole | Landsoprazole

What is Zollinger-Ellison syndrome?

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.

What can cause stress ulceration?

``` Severe burns Raised ICP Sepsis Severe burns Multiple organ failure ```

How does stomach cancer present?

Has tube large before symptoms: - Dysphagia - Loss of appetite - Malaena - Weight loss - Nausea / vomitting - Virchows nodes (enlarged lymph node)

What are some risk factors for stomach cancer?

Male H. Pylori Dietary factors Smoking