Stomach

Question 1

What is portal hypertensive gastropathy?

Answer 1

Development of hyperaemic, friable gastric mucosa with increased blood flow in patients with portal HTN
Seen in 20-98% of patients with portal HTN
Does not correlate to severity of portal HTN but does correlate to degree of portal pressure
Due to increased mucosal blood flow, inflammation, possible mucosal ischaemia
Usually asymptomatic/chronic bleed/FeD
Dx: snakeskin mucosa (white reticular pattern and pink mucosa; oozing, bleeding, submucosal haemorrhage)
DDx: GAVE (also associated with cirrhosis)
Rx: beta blocker for pHTN, iron replacement, terlipression/octreotide for massive bleed

Question 2

What is the pathogenesis of H. pylori ulceration of stomach and duodenum

Answer 2

H. pylori has virulence factors:
- burrowing to mucosa
- urease neutralising gastric acid to NH4 and CO2
- production of vacA

vacA causes direct gastric mucosal injury
NH4 causes gastric mucosal injury
NH4 and the bacteria itself causes decreased bicarb secretion in duodenum, thus making it more susceptible to ulceration from stomach acid