Stomach

Question 1

define gastritis

Answer 1

inflammation of the stomach

Question 2

causes of gastritis

Answer 2

• H. pylori
• autoimmune
  NSAIDs
  alcohol

Question 3

presentation of gastritis

Answer 3

• indigestion
• vomiting
• feeling of fullness
  autoimmune presents with pernicious anaemia as there are serum autoantibodies to gastric parietal cells

Question 4

diagnosis of gastritis

Answer 4

H. pylori by blood, stool or breath test

endoscopy

Question 5

management of gastritis

Answer 5

eradicate H. pylori

PPIs, H2RAs

Question 6

what is Zollinger-Ellison syndrome

Answer 6

formation of one or more tumours in the pancreas or duodenum (gastrinomas) which secrete excess gastrin leading to excessive acid production

Question 7

presentation of Zollinger-Ellison syndrome

Answer 7

• haematemesis
• weight loss and decreased appetite
• reflux and pain

Question 8

diagnosis of Z-E syndrome

Answer 8

• bloods for elevated gastrin (not diagnostic)
• endoscopy
• USS

Question 9

management of Z-E syndrome

Answer 9

• remove tumours (surgery, embolisation, radiofrequency ablation)
• PPIs to decrease acid production

Question 10

risk of PPIs in elderly

Answer 10

increase risk of fractures

Question 11

what increases the risk of gastric cancer

Answer 11

achlorhydria (lack of HCl) e.g. H. pylori

Question 12

causes of gastric cancer

Answer 12

• H. pylori
• pernicious anaemia (lack of red blood cells due to reduced B12)
• Lynch syndrome
• Menetrier’s disease

Question 13

define Menetrier’s disease

Answer 13

hyperplasia of gastric pits increasing mucosa thickness causing epigastric pain and peripheral oedema

Question 14

classification of stomach cancers

Answer 14

1. benign- polyps

2. malignant- carcinomas, lymphomas (maltomas) and GISTs

Question 15

presentation of stomach cancer

Answer 15

• dyspepsia and heartburn
• weight loss
• haematemesis
• Virchow’s node (left supraclavicular)

Question 16

diagnosis of stomach cancer

Answer 16

• endoscopy with biopsy to show signet rings (linitis plastica)
• CT to stage

Question 17

define linitis plastica

Answer 17

adenocarcinoma not associated with H. pylori

Question 18

management of stomach cancer

Answer 18

• gastrectomy
• chemo and radio
• herceptin for stomach cells producing HER2
• imatinib for GIST

Question 19

define gastroparesis

Answer 19

delayed gastric emptying without a physical obstruction

Question 20

causes of gastroparesis

Answer 20

idiopathic
drug-related e.g. cannabis
systemic sclerosis
diabetes

Question 21

presentation of gastroparesis

Answer 21

• fullness
• weight loss
• vomiting

Question 22

diagnosis of gastroparesis

Answer 22

• gastric emptying studies

- endoscopy for physical obstruction

Question 23

management of gastroparesis

Answer 23

• liquid diet, little and often
• motility agents
• gastric pacemaker

Question 24

define dyspepsia

Answer 24

indigestion

Question 25

presentation of dyspepsia

Answer 25

• epigastric pain/burning
• postprandial fullness and early satiety
• obstruction

Question 26

diagnosis of dyspepsia

Answer 26

• endoscopy

- AXR for obstruction

Question 27

management of dyspepsia

Answer 27

• diet
• avoid NSAIDS
• PPIs, H2RAs

Question 28

define anaemia

Answer 28

deficiency of iron in Hb

Question 29

presentation of anaemia

Answer 29

• pallor conjuctiva
• mucosal pallor
• oral ulceration, glossitis and angular cheilitis (predisposition to candida)
• tiredness, SOB, presyncope

Question 30

diagnosis of anaemia

Answer 30

• FBC

Question 31

management of anaemia

Answer 31

• iron, folic acid and B12 supplements

- for haemolytic anaemia then blood transfusions and/or plasmapheresis

Question 32

define haemolytic anaemia

Answer 32

abnormal break down of red blood cells

Question 33

adverse of PPIs in older people?

Answer 33

increased fracture risk