Session 5 - Pathology Of The Stomach

Question 1

What is dyspepsia?

Answer 1

A group of symptoms relating to pain or discomfort in the upper GI tract.

Question 2

Give examples of common gastric disorders.

Answer 2

Gastrooesphageal reflux disease
Gastritis
Peptic ulcer disease 
Zollinger-Ellison 
Stress ulcers
Cancer of the stomach

Question 3

What is gastritis?

Answer 3

Inflammation of the mucosa of the stomach. Can be acute or chronic. Most common symptom is upper abdominal pain.

Question 4

What is gastro-oesophageal reflux disease (GORD)?

Answer 4

Reflux of stomach contents into the oesophagus (more than normal)

Question 5

What are the symptoms of gastro-oesophageal reflux disease?

Answer 5

Heartburn
Cough
Sore throat
Dysphagia

Question 6

What are the possible causes of gastro-oesophageal reflux disease?

Answer 6

Lower oesophageal sphincter problems
Delayed gastric emptying (raised intra-gastric pressure)
Hiatus hernia
Obesity

Question 7

What is a hiatus hernia?

Answer 7

When part of the stomach protrudes up into the thorax through an opening n the diaphragm.

Question 8

What problems can gastro-oesophageal reflux disease cause?

Answer 8

Oesophagitis
Strictures (narrowing)
Barrett’s oesophagus

Question 9

What is Barrett’s oesophagus and what does in cause an increased risk of?

Answer 9

Metaplasia in the oesophagus of squamous epithelium to columnar.
Increased risk of developing adenocarcinoma.

Question 10

What treatment can be used for gastro-oesophageal reflux disease?

Answer 10

Lifestyle modifications

Pharmacological:

• Antacids - form an alkaline layer on top of stomach acid, less likely to reflux
• H2 antagonists - block histamine receptor, less HCl produced
• Proton Pump Inhibtiors (PPIs)

Surgery (rare)

Question 11

What are the possible causes of acute gastritis?

Answer 11

Heavy use of NSAIDs
Lots of alcohol
Chemotherapy
Bile reflux

Question 12

What are the symptoms of acute gastritis?

Answer 12

Pain, nausea, vomiting, occasionally bleeding (which can be fatal)

Or

Asymptomatic

Question 13

What are the possible causes of chronic gastritis?

Answer 13

Bacterial
- H pylori infection (most common)

Autoimmune

• antibodies to gastric parietal cell
  
  • can lead to pernicious anaemia

Question 14

What are the symptoms of chronic gastritis?

Answer 14

H pylori:

• asymptomatic or similar to acute gastritis (pain, nausea, vomiting)
• symptoms may develop due to complications
  
  • e.g. peptic ulcers, adenocarcinoma, MALT lymphoma

Autoimmune:

• symptoms of anaemia
• glossitis
• anorexia
• neurological symptoms

Question 15

Peptic ulcer disease most commonly affects which part of the stomach?

Answer 15

Lesser curvature

Question 16

What is peptic ulcer disease?

Answer 16

Defect in gastric/duodenal mucosa.
Must extend through the muscularis mucosa.
Most common in the first part of the duodenum, but also commonly affects the lesser curve of the stomach.

Question 17

What causes peptic ulcer disease?

Answer 17

Caused by mucosal injury due to:
- stomach acid
- H pylori
- NSAIDs
Also
- massive physiological stress (e.g. burns)
- smoking (only really contributes to relapse of peptic ulcer disease)

Question 18

What are the symptoms of peptic ulcer disease?

Answer 18

Epigastric pain (sometimes back pain):
- burning/gnawing 
- after meal times
- often at night 
Serious symptoms:
- bleeding/anaemia
- satiety 
- weight loss

Question 19

What investigations can be used when diagnosing gastric pathologies?

Answer 19

Upper GI endoscopy - biopsies (look for benign, malignant, H pylori)
Urease breath test - detects H pylori
Erect chest X-ray - looks for perforations
Blood test - anaemia

Question 20

What treatment can be used to eradicate H pylori?

Answer 20

Triple therapy:

PPI + Clarithromycin + Amoxicillin

Question 21

Give an example of a proton pump inhibitor (PPI).

Answer 21

Omeprazole

Question 22

Give two examples of H2 blockers.

Answer 22

Cimetidine

Ranitidine

Question 23

How is helicobacter-pylori spread?

Answer 23

Oral to oral

Faecal to oral

Question 24

How does helicobacter-pylori survive in the stomach?

Answer 24

Produces urease:
- converts urea to ammonium, increases local pH, protects it from stomach acid
Has flagellum:
- good motility, lives in mucus layer, adheres to gastric epithelia

Question 25

How does helicobacter-pylori damage the mucosa of the stomach?

Answer 25

Releases cytotoxins - direct epithelial injury
Expresses enzymes - urease —> ammonia toxic to epithelia
Degrades mucus layer
Promotes inflammatory response

Question 26

What location of colonisation of H pylori is most likely to cause duodenal ulceration?

Answer 26

Antrum

Question 27

What are the possible causes of stress ulceration?

Answer 27

Severe burns
Raised intracranial pressure
Sepsis
Severe trauma
Multiple organ failure

Question 28

What is Zollinger-Ellison disease?

Answer 28

Pancreatic tumour that releases gastrin.