Paul Mueller- Heartburn

Question 1

What re the 5 common causes of dyspepsia?

Answer 1

GORD
Gastritis
Functional dyspepsia
Stress
Peptic ulcer disease

Question 2

What investigations would be prioritised with a presentation of dyspepsia?

Answer 2

• ECG
• Weight
• Alcohol history (XS= chronic gastritis –>dyspepsia)
• Medication history (may include meds that affect gastric mucosa or relax sphincter -> reflux)
• Test for H.pylori
• Full blood count (Identify anaemia and/or thrombocytosis to indicate upper GI malignancy)
• Liver function tests (Biliary disease, alcohol induced changes?)

Question 3

How does H.pylori usually colonise the stomach?

Answer 3

Ingestion

Question 4

How does H.pylori survive in the acidic environment of the stomach?

Answer 4

Acid neutralisation and locomotion

Question 5

How does H.pylori neutralise stomach acid?

Answer 5

• Synthesises urease that catalyses conversion of urea and water into ammonia and CO2
• Ammonia is basic so neutralises stomach acid creating layer around H.pylori

Question 6

How does H.pylori use locomotion?

Answer 6

• HP has flagella which propels it into the mucus layer where pH is much safer

Question 7

How does H.pylori adhere to th host?

Answer 7

Uses LPS/BabA molecules to adhere to cells on stomach lining.

Question 8

How does HP become a potential pathogen?

Answer 8

Production of toxins:
- cagA disrupts tight junction between stomach lining cells leading to gastritis
- vacA causes cells in stomach lining to undergo apoptosis and die
- This disrupts continuity of stomach lining so underlying cells exposed to HCl leading to stomach ulcers

Question 9

What are the three types of drugs used to treat H.pylori and dyspepsia?

Answer 9

• Proton pump inhibitors
• H2 Antagonist
• Antacids - neutralise HCl

Question 10

What is the definition of a red flag?

Answer 10

Signs and symptoms found in patient history and clinical exam that are indicators of a possible serious unerlying condition

Question 11

What are the red flag features of upper GI cancers

Answer 11

-Dysphagia
- Weight loss
- Anaeia

Question 12

What is the treatment regimen for H.pylori?

Answer 12

• Omeprazole
• Amoxicillin
• Clarithromycin
  Then CARBON 13 breath test to test for H.pylori

Question 13

What is the treatment regimen for when H.pylori is negative yet dyspepsia persist?

Answer 13

Omeprazole then Ranitidine

Question 14

What type of medication is omeprazole and lanzaprazole?

Answer 14

PPIs

Question 15

Why is the carbnon 13 breath test used?

Answer 15

Only test validated by NICE as a test of cure

Question 16

When can the carbon 13 test be used?

Answer 16

POST two weeks of no PPis and 4 weeks of no antibiotics so avoid false negatives

Question 17

If dyspepsia persists after second line treatment, what is the protocol?

Answer 17

Non urgent upper GI endoscopy
(OGD) for treatment resistant dyspepsia.

Question 18

What is a hiatus hernia

Answer 18

When part of the abdominal viscera herniate through the oesphageal hiatus in the diaphragm

Question 19

What are the risk factors for a hiatus hernia?

Answer 19

• Male
• Obesity
• Age
• Pregnancy
• Genetic predisposition

Question 20

What are the mechanisms for the formation of a hiatus hernia?

Answer 20

• Widening of the diaphragmatic hiatus
• Pulling up of the stomach
• Pushing up of the stomach

Question 21

What causes refluc with a hiatus hernia?

Answer 21

Lower oesophageal sphincter compromised and antireflux barrier lost

Question 22

What are the 2 variants of a hiatus hernia

Answer 22

Sliding and rolling

Question 23

What happens to GOJ in a sliding hiatus hernia compared to rolling?

Answer 23

sliding: GOJ moves upwards
rolling: GOJ stays in same place

Question 24

How common is a sliding hiatus hernia compared to rolling?

Answer 24

sliding: 85-95% of cases
rolling: 5-15% of cases

Question 25

What kind of symptoms does a sliding hiatus hernia cause?

Answer 25

Symptoms of GORD

Question 26

What is Barrett’s Oesphagus?

Answer 26

Metaplasia of lower oesophageal squamous epithelium to gastric columnar epithelium