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GI > Stomach > Flashcards

Stomach Flashcards

1
Q

What’s the most common type of gastric cancer?

A

Adenocarcinoma

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2
Q

Name 4 risk factors for gastric cancers

A 
H. Pylori infection 
Alcohol
Smoking
High nitrate food 
Low socioeconomic status 
Atrophic gastritis 
Ulcers , GORD
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3
Q

What type of anaemia can be seen with gastric cancer ?

A

Chronic iron deficiency anaemia

Or

Pernicious anaemia 
( complication ) due to autoimmune distraction of parietal cell causing lack of intrinsic factor and therefor lack of B12
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4
Q

What’s the gastric outlet syndrome ?

What can be heard on auscultation?

A 
Obstruction of gastric outlet leading to post Prandial vomiting ( non- billious ) early satiety, progressive dilatation of stomach, weight loss 
Metabolic acidosis ( hypokalaemia , hypochloraemic )
On auscultation : succussion splash
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5
Q

Name common symptoms a gastric carcinoma may present with

A 
Often asymptomatic until late 
Dyspepsia 
Nausea, vomiting
Post prandial full was
Anaemia 
Abdominal pain 
Weight loss 
Gastric outlet syndrome
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6
Q

Which 2 lymph nodes would be enlarged in a patient with gastric cancer?

A 
Virchows node ( left supraclavicular, thoracic duct joins subclavian vein )
Sister Mary Jospehs node (periumbilical )
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7
Q

Describe the dumping syndrome - when does it occur ?

A

Occurs after gastrectomy

Post prandial hypoglycaemia , decreases consciousness

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8
Q

Name 3 complications of gastric cancer and it’s treatment .

A

Post gastrectomy: maldigestion, dumping syndrome , small intestine bacterial overgrowth

Acanthosis nigrans

Pernicious anaemia

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9
Q

Which paraneoplastic skin addition is associated with gastric adenocarcinoma ?

A

Acanthosis nigrans
Velvet patches in axilla , neck , genital area ,
Itching

Other causes :
DM, Cushing , obesity , PCOS

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10
Q

What is a Gastrinoma?

A

Also called Zollinger- Ellison Syndrome

A gastrin secreting neuroendocrine tumour of either duodenum or pancreas
–> increased gastric acid production

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11
Q

How may zollinger ellison syndrome present ?

A

Recurrent , therapy resistant gastric ulcers

Diarrhoea
Steatorrhea

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12
Q

Name a primary gastric lymphoma

A

MALT lymphoma
Mucosa- associated lymphoid tissue lymphoma

B cell, non-Hodgkin

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13
Q

What’s a gastric MALT lymphoma strongly associated with ?

A

H pylori

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14
Q

Name 4 cells of the stomach and their function

A

Parietal cell
- acid and intrinsic factor secretion

Mucosal cell
-protective mucous secretion

Chief cell
- pepsinogen -> proteolysis
G- cells
Gastrin

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15
Q

What is dyspepsia ? Give 3 causes

A

Heartburn , indigestion
Features like

Early satiation
Postprandial fullness
Epigastric pain

Causes 
Peptic ulcer
GORD
Functional 
Gastric cancer
Myocardial infarction
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16
Q

What are the two
Most common causes of peptic
Ulcer ?

A

NSAIDs

H pylori

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17
Q

Name risk factors for peptic ulcer disease

A

Smoking
Stress
Alcohol
Zollinger Ellison syndrome

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18
Q

How to differentiate between a gastric or duodenal ulcer , solely by the patients history ?

What are typical locations for these ulcers ?

A 
Gastric ulcer
Pain with eating
Weight loss 
Appetite loss 
Anaemia
--> Antrum and lesser curvature 
Duodenal ulcer 
Weight gain
Pain when hungry or after eating 
Relieved with milk, food 
--> duodenal bulb
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19
Q

Name the 6 alarm symptoms in a patient with suspected ulcer that results in more invasive investigation such as gastroscopy?

A 
Anaemia 
Loss of weight
Anorexia 
Recent onset / fast progression 
Melaena
Swallowing difficulty
20
Q

H. Pylori is a common cause of peptic ulcers . What is it and how does it induce inflammation?

A

Gram - bacteria
Produces ammonia by urease enzyme which raises pH and allows growth

Infection results in
Antral gastritis
Ulcers
Gastric cancer or MALT lymphoma

21
Q

If suspected h pylori infection , which investigation would you do?

A

Serology IgG
C urea breath test ( quick screening test )
Gastroscopy and urease test

22
Q

How would you treat a peptic ulcer caused by h pylori ?

A

Triple therapy
PPI
Amoxicillin
Clarithromycin / metronidazole

In
Penicillin allergy
Clarithromycin and metronidazole

23
Q

Name 3 complications of peptic ulcers

A 
Bleeding
Perforation 
Sub-hepatic abscess
Malignancy 
Gastric outlet obstruction
24
Q

What supportive measures can be performed in peptic ulcer disease ?
How to treat a h pylori negative patient ?

A

Stop NSAIDs, smoking, alcohol, avoid stress

-PPI
-h2 Blocker
Antacids

25
Q

What is menetriers disease ?

A

Giant gastric mucosal folds with atrophy, mucosal thickening , loss of protein -> low albumin and oedema
Causes by h pylori and CMV

26
Q

Name causes / risk factors of gastritis

A 
H pylori
NSAIDs
Alcohol
Hiatus hernia 
Crohns 
Sarcoidosis
Zollinger Ellison
Menetriers disease
27
Q

What is type A gastritis ?
Type B?
Type C?

A

A : autoimmune - HLA-B8 und HLA-DR3

B bacterial eh h pylori
C chemical e.g. NSAIDs and alcohol

28
Q

Which form of anaemia can result from atrophic gastritis ?

A

Pernicious anaemia
-> B12 deficiency ( lack
Of intrinsic factor by parietal cell )

29
Q

In gastritis , when to perform gastroscopy ?

A

Alarm symptoms

Persistent and treatment resistant with dysphagia or >55

30
Q

What is GORD and what is it caused by?

A

Reflux of gastric contents that causes symptoms, injury or complications.

Incompetent LOS
Hiatus hernia
Dysmobility of oesophagus

Pregnancy
Obesity
Large meals

31
Q

Name common symptoms

Of GORD

A 
Heartburn
Belching 
Increased watering 
Acid brash 
Chronic cough 
Laryngitis
32
Q

What’s achalasia ?

A

Aperistalsis of oesophagus , impaired relaxation of LOS

33
Q

In GORD

What are treatment options?

A

Weight loss, smoking cessation , avoid citrus fruits, alcohol, hot drinks , onions , caffeine , spices , NSAIDs
Lift bed up, avoid eating before bed

Anatacids
PPI
H2 antagonists
Gaviscon

Fundoplication
Magnetic bead band

34
Q

What are Schatzki rings ?

A

B- rings , stricture , at gastric junction , accompanied by hiatus hernia

35
Q

What are common complications of GORD?

A

Barrets oesophagus
Aspiration
Peptic ulcers , bleeding , anaemia
Oesophageal rings (schatzki)

36
Q

What happens in barrets oesophagus ?

How to treat it?

A

Reflux oesophagitis leads to metaplasia

Squamous epithelial replaced by columnar + goblet cells

PPI
+/- mucosal resection

37
Q

A patient presents with vomiting large volume of fresh blood. He is haemodynamically compromised . What is a likely diagnosis ?

A

Bleeding from gastric oesophageal varices

38
Q

A patient with a history of GORD presents with small volume haematemesis . What’s a likely diagnosis ?

A

Oesophagitis as cause for his GI bleed

39
Q

A patient presents with haematemesis after continuous projectile vomiting . What’s a likely diagnosis ?

A

Mallory Weiss tear

40
Q

What’s the most common cause of upper GI bleed?

A

Peptic ulcer bleeding

Common site : duodenal ulcer

41
Q

A 54 year old male presents with iron deficiency anaemia . Which cause do you have to rule out?

A

Cancer of GI tract , chronic bleed

42
Q

A 60 year old patient presents with rectal bleeding, BP of 90/60 and pulse of 115 bpm. He is unwell and pallor.
What are your first steps of the management ?

A

Take blood for group and safe –> blood transfusion
Large cannula
Fluids
Stop drugs like NSAIDs, aspirin, clopidogrel , warfarin
Oxygen
Urgent endoscopy

This patient is in shock

43
Q

A young male patient complains of constipation a rectal bleeding. He describes small amounts of bright red blood Post defecation . What’s a likely cause ?

A

Anal fissure

Haemorrhoids

44
Q

A 35 year old patient presents with bright red rectal bleeding . In his passed he had several perianal abscesses and fistula. He complains of diarrhoea . What’s a diagnosis ?

A

Crohns

45
Q

A young patient presents with weight loss, diarrhoea with bright red bleeding and occasionally mucous in his stools . What’s a diagnosis to consider ?

A

Ulcerative colitis

Consider cancer

GI (7 decks)

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