Stomach Flashcards
Conditions
What is pyloric stenosis?
Hypertrophy of the pyloric sphincter, common in first born boys
How does pyloric stenosis present?
Projectile vomiting of milk
Child dehydrated, hungry and dry
Can palpate an “olive”
How can pyloric stenosis be investigated?
Test feed
Ultrasound
Bloods will be low in K+ and Cl-, must be treated pre-surgery
What is the treatment for pyloric stenosis?
Cut through the pyloric sphincter muscles
What cancer is common in the stomach?
Usually adenocarcinoma
Name three risk factors for stomach cancer?
Smoking Ulcers Long standing mucosal injury H. Pylori gastritis Pernicious anaemia Blood Group A
How does stomach cancer present?
Slow onset, late to present Loss of appetite Weight loss Vomiting Enlarged lymph nodes Stomach mass Intestinal mets (lymph)
What investigations are carried out for potential stomach cancer?
Bloods - anaemia, EUC, gastrin
CT
Ultrasound
Gastroscopy
What is the treatment for stomach cancer?
Normally chemo and radiotherapy to make it operable
High chance of mets, often treated with total gastrectomy
What is included in a total gastrectomy?
Bottom of the oesophagus
Stomach
First part of the duodenum
What group is at higher risk of gastric ulceration?
Older males (worse with food)
What group is at higher risk for duodenal ulceration?
Younger males
better with food, worse at night
What complications can arise from ulceration?
Perforation (into body cavity, causing peritonitis)
Penetration (erodes into something else, e.g. organ)
Haemorrhage (eroded blood vessel at base of ulcer)
What is dyspepsia?
Indigestion, diagnostic dead end
Treatment with placebo effective in up to 60%
What bacteria can lead to gastric and duodenal ulcers?
H. Pylori (gram negative)
How does H. Pylori cause ulcers?
Attacks epithelial cells causing inflammatory response (ineffective against HP)
H. Pylori converts urea to NH3, increasing the stomach pH
What tests can confirm/rule out H. Pylori?
C13 labelled breath test (urea)
Stool antigen test (off PPIs for 2 weeks prior)
How can H. Pylori be treated?
Triple therapy for 7 days
How might H. Pylori infected patients present?
With haematemesis/melaena
What does triple therapy consist of?
PPI (e.g. Omeprazole)
Clarithromycin
Amoxicillin
What can develop in the overuse of NSAIDs?
Acute (NSAID induced) gastritis
How does NSAID overuse cause gastritis?
Exfoliation of the surface epithelium
Mucus secretion is reduced so stomach is eroded
Ulcers develop, erosion below the muscularis mucosa
NSAID induced gastritis is common in?
Elderly women taking NSAIDs for arthritis
How can NSAID induced ulcers be treated?
Stop use of NSAID and use a replacement
What is chronic gastritis
Autoimmune disease where antibodies are produced against parietal cells and intrinsic factor binding sites
What anaemia is present in chronic gastritis?
Pernicious anaemia (low B12) Gastritis with macrocytic anaemia
