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Semester 3 - Gastrointestinal > Session 5 - Disorders of the Stomach > Flashcards

Session 5 - Disorders of the Stomach Flashcards

1
Q

Name four common disorders of the stomach

A
  • Gastritis
  • Gastric/duodenal ulceration
  • Gastric cancer
  • Gastro-oesophageal reflux disease
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2
Q

What is the main symptom of gastric/duodenal ulceration?

A

• Upper abdominal pain

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3
Q

Give three complications of gastric/duodenal ulceration

A
  • Bleeding
  • Perforation
  • Gastric outlet obstruction
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4
Q

What is gastritis?

A
  • Mucosal inflammation

* Mucosal breakdown

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5
Q

What is GORD?

A

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

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6
Q

Give four physiological adaptions designed to prevent reflux

A
  • 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
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7
Q

Give a clinical feature of GORD

A

• Dyspepsia

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

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8
Q

How is GORD investigated?

A
  • Clinical diagnosis made on history alone

* Investigations used if dyshagia present or hiatus hernia suspected

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9
Q

What are two overarching methods of managing GORD?

A
  • Lifestyle

* Medication

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10
Q

Give three changes in lifestyle which can prevent GORD

A
  • Lose weight
  • Stop smoking
  • Reduce alcohol intake
  • Reduce consumption of aggravating foods
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11
Q

Give four medications which can be used to medicate GORD

A
  • Simple antacids (CaCO3)
  • Raft antacids (Gaviscone, creates protective raft which sits on top of stomach contents to prevent reflux
  • PPI
  • H2 antagonist
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12
Q

Give a complication of GORD

A
  • Barrets-oesophagus

* Stratified squamous cells -> Gastric cells

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13
Q

Why do anti-cholinergics increase risk of GORD?

A

• Relax LOS

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14
Q

What proportion of population over 50 have gastric leiomyoma?

A

• 50%

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15
Q

What is a gastric leiomyoma?

A

• Benign tumour which is often accidentally discovered

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16
Q

What is the frequency of gastric carninoma?

A

• 15/100,000

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17
Q

What are the main symptoms of gastric carcinoma?

A

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

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18
Q

How is gastric carcinoma diagnosed?

A
  • Endoscopy

* Barium meal

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19
Q

What are two types of gastric carcinoma?

A
  • Glandular adenocarcinoma

* Diffuse, spreading type adenocarcinoma

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20
Q

What is chronic gastritis?

A

• Chronic inflmmation of stomach lining

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21
Q

What is a key symptom of chronic gastritis?

A

• pernicious anaemia

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22
Q

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

A
  • Loss of parietal cells
  • Less intrinsic factor
  • Less absorption of B12 (needs intrinsic factor)
  • Down with RBC
23
Q

What is peptic ulcer disease?

A

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

24
Q

Where are duodenal ulcers usually found?

A

• In duodenal cap

25
Q

Where are gastric ulcers usually found?

A

Lesser curvature of the stomach

26
Q

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

A
  • More contact with irritants

* More exposure to ulcerogenic refluxed acid

27
Q

What is a peptic ulcer?

A

• Gastric ulcers are exclusively stomach related

Peptic ulcers can be stomach related, but are predominantly duodenal

28
Q

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

A
  • H pylori

* NSAIDS

29
Q

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

A
  • 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
30
Q

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

A

15%

31
Q

How many times more common are duodenal ulcers than gastric?

A

• 4:1 times

32
Q

Give general symptoms of peptic ulcers

A
  • Recurrent, burning epigastric pain
  • Nausea
  • Vomiting
33
Q

How does the diagnosis of duodenal ulcers differ from gastric?

A
  • Duodenal ulcers - Pain worse at night and when hungry, relieved by eating
  • Gastric ulcers - Pain caused by eating food
34
Q

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

A

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

35
Q

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

A

• Gastric carcinoma

36
Q

Outline three investigations for suspected peptic ulcers

A
  • Investigate H. Pylori
  • Endoscopy
  • Barium meal
37
Q

What is the management of peptic ulcer disease?

A

• If due to H pyloiri infection, triple therapy

Review NSAID use

38
Q

What is a major complication of peptic ulcer disease?

A
  • Iron defiency anaemia due to acute GI bleed
  • Haematmesis and melena
  • Perforation into peritoneal cavity

Gastric outlet obstruction

39
Q

Where can a gastric obstruction be present?

A

Where can a gastric obstruction be present?

• Pre-pyloric, pyloric or duodenal

40
Q

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

A

• Oedema with active ulcer

Fibrosis of ulcer

41
Q

What does persistent penetrating pain from peptic ulcer indicate?

A

• Penetration of ulcer to other organs

42
Q

What is H pylori?

A
  • Bacteria - Gram negative
  • Motile, aerobic
  • Urease producing
  • Adheres to gastric mucosa
  • Produces cytotoxins
  • Strong association with gastritis
43
Q

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

A

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

44
Q

How is H pylori diagnosed?

A
  • IgG detected in serum (good sensitivity and specificity)
  • 13C-urea breath test
  • Gastric sample by endoscopy and detect by histology and culture
45
Q

What is the 13Curea-breath test?

A
  • 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
46
Q

Give one thing other than helicobacter pylori which causes gastric ulceration

A

• NSAIDS

47
Q

Outline the treatment for Helicobacter pylori

A

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

48
Q

How effective is standard eradication therapy of H. Pylori?

A

• 80-90% chance of eradication

49
Q

Outline three diseases which H.pylori increase risk of

A
  • Gastritis
  • Peptic ulcer disease
  • Gastric disease
50
Q

What does chronic gastritis cause?

A

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

51
Q

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

A

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

52
Q

How does H. Pylori cause peptic ulcers?

A

• Causes elevated levels of gastrin due to G-cell hyperplasia, predisposing to gastric ulceration

Less HCO3- produced, lives in mucus

53
Q

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

A

• H2 antagonists

PPI

Semester 3 - Gastrointestinal (28 decks)

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