Mucosal inflammation Mucosal breakdown

Session 5 - Disorders of the Stomach Flashcards by Matt Quinn

Name four common disorders of the stomach

Gastritis
Gastric/duodenal ulceration
Gastric cancer
Gastro-oesophageal reflux disease

How well did you know this?

Not at all

Perfectly

What is the main symptom of gastric/duodenal ulceration?

• Upper abdominal pain

How well did you know this?

Not at all

Perfectly

Give three complications of gastric/duodenal ulceration

Bleeding
Perforation
Gastric outlet obstruction

How well did you know this?

Not at all

Perfectly

What is gastritis?

Mucosal inflammation

* Mucosal breakdown

How well did you know this?

Not at all

Perfectly

What is GORD?

• Anti-reflux mechanism fail and there is prolonged contact of gastric juices with lower oesoophageal mucosa

How well did you know this?

Not at all

Perfectly

Give four physiological adaptions designed to prevent reflux

Lower oesophageal sphincter – which is usually closed and transiently relaxes as part of physiology of swallowing to allow bolus to move into stomach
Oesophagus enters stomach in abdominal cavity
Pressure in abdominal cavity is higher than that of thoracic
Right crus of diaphragm acts as sling around the lower oesophagus

How well did you know this?

Not at all

Perfectly

Give a clinical feature of GORD

• Dyspepsia

○ Worse on lying down, bending over and when drinking hot drinks

How well did you know this?

Not at all

Perfectly

How is GORD investigated?

Clinical diagnosis made on history alone

* Investigations used if dyshagia present or hiatus hernia suspected

How well did you know this?

Not at all

Perfectly

What are two overarching methods of managing GORD?

Lifestyle

* Medication

How well did you know this?

Not at all

Perfectly

Give three changes in lifestyle which can prevent GORD

Lose weight
Stop smoking
Reduce alcohol intake
Reduce consumption of aggravating foods

How well did you know this?

Not at all

Perfectly

Give four medications which can be used to medicate GORD

Simple antacids (CaCO3)
Raft antacids (Gaviscone, creates protective raft which sits on top of stomach contents to prevent reflux
PPI
H2 antagonist

How well did you know this?

Not at all

Perfectly

Give a complication of GORD

Barrets-oesophagus

* Stratified squamous cells -> Gastric cells

How well did you know this?

Not at all

Perfectly

Why do anti-cholinergics increase risk of GORD?

• Relax LOS

How well did you know this?

Not at all

Perfectly

What proportion of population over 50 have gastric leiomyoma?

• 50%

How well did you know this?

Not at all

Perfectly

What is a gastric leiomyoma?

• Benign tumour which is often accidentally discovered

How well did you know this?

Not at all

Perfectly

What is the frequency of gastric carninoma?

• 15/100,000

How well did you know this?

Not at all

Perfectly

What are the main symptoms of gastric carcinoma?

• Abdominal pain
• Weight loss
• NAV (nausea, vomiting, anorexia)
Anaemia

How well did you know this?

Not at all

Perfectly

How is gastric carcinoma diagnosed?

Endoscopy

* Barium meal

How well did you know this?

Not at all

Perfectly

What are two types of gastric carcinoma?

Glandular adenocarcinoma

* Diffuse, spreading type adenocarcinoma

How well did you know this?

Not at all

Perfectly

What is chronic gastritis?

• Chronic inflmmation of stomach lining

How well did you know this?

Not at all

Perfectly

What is a key symptom of chronic gastritis?

• pernicious anaemia

How well did you know this?

Not at all

Perfectly

How does pernicous anaemia come about as a result of chronic gastritis?

Loss of parietal cells
Less intrinsic factor
Less absorption of B12 (needs intrinsic factor)
Down with RBC

What is peptic ulcer disease?

• A break in superficial epithelial cells penetrating down into muscularis mucosa of either stomach or duodenum

Where are duodenal ulcers usually found?

• In duodenal cap

Where are gastric ulcers usually found?

Lesser curvature of the stomach

Why are gastric ulcers usually found in less curvature of the stomach?

* More contact with irritants | * More exposure to ulcerogenic refluxed acid

What is a peptic ulcer?

• Gastric ulcers are exclusively stomach related | Peptic ulcers can be stomach related, but are predominantly duodenal

Give the two leading causes of peptic ulcers in the developed world

* H pylori | * NSAIDS

How do non-steroidal anti-inflammatory drugs cause peptic ulcers?

* Inhibits cox-1, enzyme response for conversion of arachidonic acid to prostaglandin * Prostaglandins produce protective unstirred layer of mucus This is lost with NSAID use

What % of patients have duodenal ulcers at somepoint in their lives?

15%

How many times more common are duodenal ulcers than gastric?

• 4:1 times

Give general symptoms of peptic ulcers

* Recurrent, burning epigastric pain * Nausea * Vomiting

How does the diagnosis of duodenal ulcers differ from gastric?

* Duodenal ulcers - Pain worse at night and when hungry, relieved by eating * Gastric ulcers - Pain caused by eating food

What can occur after a long period of time with a gastric ulcer

• Ulcer can perforate blood vessels, causing haematamesis (vomiting of blood)

What can the clinical features of gastric ulcers be confused for?

• Gastric carcinoma

Outline three investigations for suspected peptic ulcers

* Investigate H. Pylori * Endoscopy * Barium meal

What is the management of peptic ulcer disease?

• If due to H pyloiri infection, triple therapy Review NSAID use

What is a major complication of peptic ulcer disease?

* Iron defiency anaemia due to acute GI bleed * Haematmesis and melena * Perforation into peritoneal cavity Gastric outlet obstruction

Where can a gastric obstruction be present?

Where can a gastric obstruction be present? | • Pre-pyloric, pyloric or duodenal

What is gastric obstruction as a result of peptic ulcer due to?

• Oedema with active ulcer Fibrosis of ulcer

What does persistent penetrating pain from peptic ulcer indicate?

• Penetration of ulcer to other organs

What is H pylori?

* Bacteria - Gram negative * Motile, aerobic * Urease producing * Adheres to gastric mucosa * Produces cytotoxins * Strong association with gastritis

How do H pylori survive the acidic conditions of the stomach?

• Production of urease produces ammonia, which neutralises acidic environment which allows bacterium to survive

How is H pylori diagnosed?

* IgG detected in serum (good sensitivity and specificity) * 13C-urea breath test * Gastric sample by endoscopy and detect by histology and culture

What is the 13Curea-breath test?

* 13Curea ingested - If H.pylori present the urease produced will break down 13C-urea to NH3 and CO2 * Carbon 13 will be detected in CO2 on exhalation

Give one thing other than helicobacter pylori which causes gastric ulceration

• NSAIDS

Outline the treatment for Helicobacter pylori

• Triple therapy ○ PPI - omeprazole ○ Two antibiotics - Clarithomycin/amoxicillin ○ H2 anatagonist

How effective is standard eradication therapy of H. Pylori?

• 80-90% chance of eradication

Outline three diseases which H.pylori increase risk of

* Gastritis * Peptic ulcer disease * Gastric disease

What does chronic gastritis cause?

• Hypergastrinaemia due to gastrin release from astral G cells -> This increased acid production is usually asymptomatic, but can lead to duodenal ulceration

What factors are implicated in the development of duodenal ulcers in people with H.pylori

• Genetic predispositions, bacterial virulence, increased gastrin secretion and smoking

How does H. Pylori cause peptic ulcers?

• Causes elevated levels of gastrin due to G-cell hyperplasia, predisposing to gastric ulceration Less HCO3- produced, lives in mucus

Give two ways in which acid secretion may be reduced by drugs

• H2 antagonists | PPI