Pathophysiology Of Gastric Disease Flashcards
What is dyspepsia?
A complex of upper GIT symptoms which present for 4+ weeks.
Including: upper abdominal pain, heartburn, acid reflux, nausea and vomiting.
Identify 5 common gastric disorders.
- GORD.
- Gastritis.
- Peptic Ulcer Disease.
- Zollinger-Ellison Disease.
- Stomach Cancer.
What are the common symptoms of Gastro-Oesophageal Reflux Disease?
- Chest pain.
- Acidic taste in mouth.
- Cough.
What are the potential outcomes of GORD?
- Nothing.
- Oesophagitis.
- Strictures.
- Barrett’s oesophagus.
What characteristics of the Lower Oesophageal Sphincter prevent GORD?
- Muscular element.
- Right crus of diaphragm.
- Angle of entry of oesophagus into the stomach.
- Intra-abdominal pressure.
What classifies as the Lower Oesophageal Sphincter?
The distal 4cm of the oesophagus that has a lower pressure after meals and a higher pressure at night.
How can you treat GORD?
- Lifestyle modification.
- Pharmacological: antacids, H2 agonists and PPI.
- Surgery (uncommon) where the fundus of the stomach is wrapped around the base of the oesophagus.
What is the link between GORD and hiatal hernias?
If someone has a hiatal hernia they are much more likely to get GORD. It is due to moving the LOS, which reduces the basal tone and thus reflux is easier.
What is Gastritis?
Inflammation of the stomach mucosa with a symptom complex of pain, nausea, vomiting and bleeding).
Has a endoscopic red hyperaemic appearance.
What can cause Acute Gastritis?
- Heavy use of NSAIDS: decrease prostaglandin and thus decrease blood flow to mucosa.
- Lots of alcohol: dissolving mucus.
- Chemotherapy: affecting cell rapid turnover.
- Bile reflux.
Basically anything that exposes the mucosa to chemical injury causes damage and reduction in mucus production.
How does the Mucosa respond to chemical injury?
Vasodilation and oedema occurs and there is appearances of inflammatory cells (mainly neutrophils as in acute inflammation).
How do you treat acute gastritis?
Remove the irritant.
What can cause Chronic Gastritis?
- Bacterial: H-pylori infection.
- Autoimmune: antibodies against the parietal cells which can lead to pernicious anaemia from a lack of intrinsic factor and thus B12.
- Chemical/reactive: Chronic alcohol abuse, NSAIDS or reflux of bile.
What are the symptoms of H-pylori causes Chronic Gastritis?
Asymptomatic or nausea, vomiting, bleeding, pain.
What complications can arise from H-pylori chronic gastritis?
- Peptic ulcer.
- Adenocarcinoma.
- MALT lymphoma.
What are the symptoms of autoimmune chronic gastritis?
- Megaloblastic anaemia.
- Glossitis (swollen tongue).
- Anorexia.
- Neurological symptoms.
What is the structure of Helicobacter pylori bacteria?
Helix shaped.
Gram negative.
Microerophilic (like between anaerobic and aerobic areas).
How is Helicobacter Pylori spread?
Oral to oral/faecal to oral.
What makes Helicobacter pylori good at damaging the stomach?
- Produces urease: converting urea to ammonium which increases the local pH. Ammonia is toxic to epithelia.
- Has flagella so has good motility. Living in the mucus layer and adhering to the gastric epithelia.
- Releases cytotoxins: direct epithelial injury.
- Promote inflammatory response.
What will happen if the Helicobacter Pylori colonisation is in the antrum?
G cells are found in the antrum so there is increased gastrin secretion and so increased parietal acid secretion. This can lead to duodenal epithelial metaplasia and colonisation of the duodenum resulting in duodenal ulceration.
What are the symptoms if the Helicobacter colonisation is found in the antrum and the body?
Asymptomatic- balance each other out.
What are the consequences of a body only Helicobacter pylori colonisation?
Atrophic effect on the parietal cells. Can lead to a gastric ulcer, leading to intestinal metaplasia-> dysplasia-> cancer.
How can you diagnose Helicobacter pylori?
- Urea breath test.
- Stool antigen test.
- Blood test.
How do you treat someone with a Helicobacter Pylori infection?
- Proton pump inhibitors.
2. Amoxicillin + clarithromycin/metronidazole.
