Peptic Ulcer Disease/Gastric Cancer Flashcards
How does peptic ulcer disease present?
Epigastric pain
- worst after eating
- radiated to back
- relived by antacids
Can be asymptomatic
Until presents with emergency e.g. GI bleed
How do you diagnose PUD?
Endoscopy
What causes gastric and duodenal ulceration?
H. pylori NSAIDS Gastric cancer Zollinger Ellison Syndrom (gastrin secreting tumour) Rarely - Crohn's - Sarcoidosis - TB
What are the complications of GI ulcers?
Bleeding
Perforation
Recurrent ulceration
Stricture formation that can lead to GI obstruction
What are the two patterns of H. pylori gastritis?
Antrum predominant
Pan-gastritis
Treatment of PUD?
Stop NSAIDS
Eradicated H. pylori (PPIs)
Check on healing of gastric ulcers with repeat endoscopy 6-8 weeks later
Breath test can be used to check for Hp eradication
If there is recurrent/extensive ulceration consider unusual causes
What are RFs for gastric cancer?
Helicobacer pylori atrophic gastritis diet salt and salt-preserved foods nitrates smoking blood group (A)
Why is H. pylori a RF for gastric cancer?
triggers inflammation of the mucosa → atrophy and intestinal metaplasia
What abdo pain is associated with gastric cancer?
typically vague, epigastric pain
may present as dyspepsia
What are the presenting features of gastric cancer?
abdo pain weight loss and anorexia nausea and vomiting dysphagia overt upper gastrointestinal bleeding (rare) can result in melaena/anaemia
What is seen if there is lymphatic spread in gastric cancer?
left supraclavicular lymph node (Virchow’s node)
periumbilical nodule (Sister Mary Joseph’s node)
What investigations are done for gastric cancer?
Endoscopy with biopsy
Staging CT
What cells are seen in gastric cancer?
Signet ring cells
Large vacuole of mucin which displaces the nucleus to one side
What is the management for gastric cancer?
surgical options depend on the extent and side but include: endoscopic mucosal resection partial gastrectomy total gastrectomy palliative surgery
chemotherapy
What cells do adenocarcinomas arise from?
Columnar glandular epithelium
Most common form of gastric cancer
What cells do lymphomas arise from?
Lymphocytes on MALT
Chronic infection can lead to B-cell proliferations, mutation and then malignancy
What cells do carcinoid tumors arise from?
G-cells in stomach
What cells do leiomyosarcomas arise from?
Smooth muscle cells
V rare
What are the 4 layers of the gastric wall?
Mucosa
Submucosa
Muscular layer
Adventitia (serosa)
What are the 3 layers of the gastric mucosa?
Epithelial (form gastric pits, coated by mucous for protection, contains parietal and chief cells)
Lamina proposa (blood, lymph etc.)
Muscularis proposa
Describe the transition from gastritis to gastric cancer?
Chronic gastritis
Local inflammation - epithelium continuously damages and repaired
METAPLASIA (resembles intestinal epithelium)
Mutations occur and accumulate leading to malignancy
What is acanthosis nigricans?
Darkening of skin around the axilla indicative of paraneoplastic syndrome (same tumour but NOT metastasis)
What is Troisier’s sign?
Enlarged Virchow’s lymphnode
What is sister mary joseph sign?
Enlarged belly button lymph node
What are the symptoms of perforation secondary to peptic ulcer disease/
epigastric pain, later becoming more generalised
patients may describe syncope
What imaging is first line when GI perforation is suspected?
Erect CXR
Look for free air under the diaphragm
