Stomach

Question 1

What is pyloric stenosis?

Answer 1

Hypertrophy of the pyloric sphincter, common in first born boys

Question 2

How does pyloric stenosis present?

Answer 2

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

Question 3

How can pyloric stenosis be investigated?

Answer 3

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

Question 4

What is the treatment for pyloric stenosis?

Answer 4

Cut through the pyloric sphincter muscles

Question 5

What cancer is common in the stomach?

Answer 5

Usually adenocarcinoma

Question 6

Name three risk factors for stomach cancer?

Answer 6

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

Question 7

How does stomach cancer present?

Answer 7

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

Question 8

What investigations are carried out for potential stomach cancer?

Answer 8

Bloods - anaemia, EUC, gastrin
CT
Ultrasound
Gastroscopy

Question 9

What is the treatment for stomach cancer?

Answer 9

Normally chemo and radiotherapy to make it operable

High chance of mets, often treated with total gastrectomy

Question 10

What is included in a total gastrectomy?

Answer 10

Bottom of the oesophagus
Stomach
First part of the duodenum

Question 11

What group is at higher risk of gastric ulceration?

Answer 11

Older males (worse with food)

Question 12

What group is at higher risk for duodenal ulceration?

Answer 12

Younger males

better with food, worse at night

Question 13

What complications can arise from ulceration?

Answer 13

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

Question 14

What is dyspepsia?

Answer 14

Indigestion, diagnostic dead end

Treatment with placebo effective in up to 60%

Question 15

What bacteria can lead to gastric and duodenal ulcers?

Answer 15

H. Pylori (gram negative)

Question 16

How does H. Pylori cause ulcers?

Answer 16

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

Question 17

What tests can confirm/rule out H. Pylori?

Answer 17

C13 labelled breath test (urea)

Stool antigen test (off PPIs for 2 weeks prior)

Question 18

How can H. Pylori be treated?

Answer 18

Triple therapy for 7 days

Question 19

How might H. Pylori infected patients present?

Answer 19

With haematemesis/melaena

Question 20

What does triple therapy consist of?

Answer 20

PPI (e.g. Omeprazole)
Clarithromycin
Amoxicillin

Question 21

What can develop in the overuse of NSAIDs?

Answer 21

Acute (NSAID induced) gastritis

Question 22

How does NSAID overuse cause gastritis?

Answer 22

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

Question 23

NSAID induced gastritis is common in?

Answer 23

Elderly women taking NSAIDs for arthritis

Question 24

How can NSAID induced ulcers be treated?

Answer 24

Stop use of NSAID and use a replacement

Question 25

What is chronic gastritis

Answer 25

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

Question 26

What anaemia is present in chronic gastritis?

Answer 26

Pernicious anaemia (low B12)
Gastritis with macrocytic anaemia