Stomach Flashcards

Conditions

1
Q

What is pyloric stenosis?

A

Hypertrophy of the pyloric sphincter, common in first born boys

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2
Q

How does pyloric stenosis present?

A

Projectile vomiting of milk
Child dehydrated, hungry and dry
Can palpate an “olive”

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3
Q

How can pyloric stenosis be investigated?

A

Test feed
Ultrasound
Bloods will be low in K+ and Cl-, must be treated pre-surgery

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4
Q

What is the treatment for pyloric stenosis?

A

Cut through the pyloric sphincter muscles

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5
Q

What cancer is common in the stomach?

A

Usually adenocarcinoma

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6
Q

Name three risk factors for stomach cancer?

A
Smoking
Ulcers
Long standing mucosal injury
H. Pylori gastritis
Pernicious anaemia
Blood Group A
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7
Q

How does stomach cancer present?

A
Slow onset, late to present
Loss of appetite
Weight loss
Vomiting
Enlarged lymph nodes
Stomach mass
Intestinal mets (lymph)
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8
Q

What investigations are carried out for potential stomach cancer?

A

Bloods - anaemia, EUC, gastrin
CT
Ultrasound
Gastroscopy

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9
Q

What is the treatment for stomach cancer?

A

Normally chemo and radiotherapy to make it operable

High chance of mets, often treated with total gastrectomy

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10
Q

What is included in a total gastrectomy?

A

Bottom of the oesophagus
Stomach
First part of the duodenum

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11
Q

What group is at higher risk of gastric ulceration?

A

Older males (worse with food)

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12
Q

What group is at higher risk for duodenal ulceration?

A

Younger males

better with food, worse at night

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13
Q

What complications can arise from ulceration?

A

Perforation (into body cavity, causing peritonitis)
Penetration (erodes into something else, e.g. organ)
Haemorrhage (eroded blood vessel at base of ulcer)

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14
Q

What is dyspepsia?

A

Indigestion, diagnostic dead end

Treatment with placebo effective in up to 60%

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15
Q

What bacteria can lead to gastric and duodenal ulcers?

A

H. Pylori (gram negative)

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16
Q

How does H. Pylori cause ulcers?

A

Attacks epithelial cells causing inflammatory response (ineffective against HP)
H. Pylori converts urea to NH3, increasing the stomach pH

17
Q

What tests can confirm/rule out H. Pylori?

A

C13 labelled breath test (urea)

Stool antigen test (off PPIs for 2 weeks prior)

18
Q

How can H. Pylori be treated?

A

Triple therapy for 7 days

19
Q

How might H. Pylori infected patients present?

A

With haematemesis/melaena

20
Q

What does triple therapy consist of?

A

PPI (e.g. Omeprazole)
Clarithromycin
Amoxicillin

21
Q

What can develop in the overuse of NSAIDs?

A

Acute (NSAID induced) gastritis

22
Q

How does NSAID overuse cause gastritis?

A

Exfoliation of the surface epithelium
Mucus secretion is reduced so stomach is eroded
Ulcers develop, erosion below the muscularis mucosa

23
Q

NSAID induced gastritis is common in?

A

Elderly women taking NSAIDs for arthritis

24
Q

How can NSAID induced ulcers be treated?

A

Stop use of NSAID and use a replacement

25
Q

What is chronic gastritis

A

Autoimmune disease where antibodies are produced against parietal cells and intrinsic factor binding sites

26
Q

What anaemia is present in chronic gastritis?

A
Pernicious anaemia (low B12)
Gastritis with macrocytic anaemia