Stomach Flashcards
define gastritis
inflammation of the stomach
causes of gastritis
- H. pylori
- autoimmune
NSAIDs
alcohol
presentation of gastritis
- indigestion
- vomiting
- feeling of fullness
autoimmune presents with pernicious anaemia as there are serum autoantibodies to gastric parietal cells
diagnosis of gastritis
H. pylori by blood, stool or breath test
endoscopy
management of gastritis
eradicate H. pylori
PPIs, H2RAs
what is Zollinger-Ellison syndrome
formation of one or more tumours in the pancreas or duodenum (gastrinomas) which secrete excess gastrin leading to excessive acid production
presentation of Zollinger-Ellison syndrome
- haematemesis
- weight loss and decreased appetite
- reflux and pain
diagnosis of Z-E syndrome
- bloods for elevated gastrin (not diagnostic)
- endoscopy
- USS
management of Z-E syndrome
- remove tumours (surgery, embolisation, radiofrequency ablation)
- PPIs to decrease acid production
risk of PPIs in elderly
increase risk of fractures
what increases the risk of gastric cancer
achlorhydria (lack of HCl) e.g. H. pylori
causes of gastric cancer
- H. pylori
- pernicious anaemia (lack of red blood cells due to reduced B12)
- Lynch syndrome
- Menetrier’s disease
define Menetrier’s disease
hyperplasia of gastric pits increasing mucosa thickness causing epigastric pain and peripheral oedema
classification of stomach cancers
- benign- polyps
2. malignant- carcinomas, lymphomas (maltomas) and GISTs
presentation of stomach cancer
- dyspepsia and heartburn
- weight loss
- haematemesis
- Virchow’s node (left supraclavicular)
diagnosis of stomach cancer
- endoscopy with biopsy to show signet rings (linitis plastica)
- CT to stage
define linitis plastica
adenocarcinoma not associated with H. pylori
management of stomach cancer
- gastrectomy
- chemo and radio
- herceptin for stomach cells producing HER2
- imatinib for GIST
define gastroparesis
delayed gastric emptying without a physical obstruction
causes of gastroparesis
idiopathic
drug-related e.g. cannabis
systemic sclerosis
diabetes
presentation of gastroparesis
- fullness
- weight loss
- vomiting
diagnosis of gastroparesis
- gastric emptying studies
- endoscopy for physical obstruction
management of gastroparesis
- liquid diet, little and often
- motility agents
- gastric pacemaker
define dyspepsia
indigestion
presentation of dyspepsia
- epigastric pain/burning
- postprandial fullness and early satiety
- obstruction
diagnosis of dyspepsia
- endoscopy
- AXR for obstruction
management of dyspepsia
- diet
- avoid NSAIDS
- PPIs, H2RAs
define anaemia
deficiency of iron in Hb
presentation of anaemia
- pallor conjuctiva
- mucosal pallor
- oral ulceration, glossitis and angular cheilitis (predisposition to candida)
- tiredness, SOB, presyncope
diagnosis of anaemia
- FBC
management of anaemia
- iron, folic acid and B12 supplements
- for haemolytic anaemia then blood transfusions and/or plasmapheresis
define haemolytic anaemia
abnormal break down of red blood cells
adverse of PPIs in older people?
increased fracture risk
