Stomach Flashcards
what is the definition of a hernia
protrusion of a whole or part of an organ through the wall of the cavity that contains it
what is a hiatus hernia
protrusion of an organ (usually stomach) from the abdominal cavity into the thorax through the oesophageal hiatus
what is the oesophageal hiatus
opening in the diaphragm through which the oesophagus and vagus nerve pass
what are the 2 types of hiatus hernia
sliding hiatus hernia
rolling or para-oesophageal hernia
risk factors for hiatus hernia
age related is the biggest factor - due to loss of diaphragmatic tone
pregnancy, obesity and ascites - all due to the raised intra-abdominal pressure and the superior displacement of the viscera
clinical features of hiatus hernia
majority are completely asymptomatic
present with; gastroesophageal reflux symptoms (burning epigastric pain), vomiting and weight loss, bleeding/anaemia, hiccups or palpitations (irritation to diaphragm or pericardial sac), early satiety (if gastric outflow is blocked/narrowed)
investigations into hiatus hernia
Oesophagogastroduodenoscopy (OGD) is the gold standard investigation
management of hiatus hernias
conservative; PPIs (omeprazole), weight loss, alteration of diet (smaller meals), smoking and alcohol cessation - both inhibit LOS function
surgical; in those that remain symptomatic or show signs of gastric outlet obstruction, two types
if there are symptoms of gastric outflow obstruction or weight loss whereby a GI malignancy may be suspected, what investigations should you do
urgent CT thorax and abdomen
what branch of the aorta supplies the majority of the stomach
coeliac trunk
what is the gold standard investigation to diagnose a hiatus hernia
OGD - oesophagogastroduodenoscopy
what are the signs/symptoms of gastric volvulus
severe epigastric pain
retching without vomiting
inability to pass NG tube
if a patient with a known large hiatus hernia presents with severe epigastric pain and retching without vomiting, what should you suspect
gastric volvulus
by what mechanism are NSAIDs responsible for causing gastric ulceration
inhibition of prostaglandin secretion
what is the definition of a peptic ulcer
its a break in the lining of the GI tract, extending through to the muscularis mucosae of the bowel wall
where are gastric ulcers most commonly found
lesser curve of stomach or duodenum
what are the 2 main causes of gastric ulcers
presence of H. pylori and prolonged use of NSAIDs
whats the difference in symptoms between gastric and duodenal ulcers
gastric ulcers - pain is exacerbated by eating
duodenal - pain is worse 2-4 hours after eating
clinical features of peptic ulcers
epigastric or retrosternal pain
nausea, bloating, early satiety
investigations into peptic ulcers
first test for H. pylori - CLO test, urease breath test, stool antigen test
those with ongoing symptoms - OGD
biopsy and send for histology due to malignant potential
what are the specific tests for H. pylori
CLO test - rapid urease test
stool antigen test
carbon-13 urea breath test
serum antibodies to H. pylori
management of peptic ulcers
conservative; lifestyle advice - smoking cessation, weight loss, reduced alcohol, stop taking NSAIDs , PPIs
surgical; rare - only in cases of perforation, partial gastrectomy performed
what is the most common type of gastric cancer
adenocarcinomas
risk factors for H. pylori infection
male gender
increasing age
H. pylori infection
smoking
alcohol consumption
(very common in far eastern countries such as japan and korea)
