Stomach Flashcards
What is a H. pylori infection?
Gram-negative urease producing bacterium
Found in gastric antrum and gastric metaplasia in the duodenum
Found in greatest numbers under the mucous layers
Oral-oral or faeco-oral mainly in childhood
More common in older population
Cure of it stops duodenal ulcer disease
Why do people get duodenal ulcers?
Increased acid secretion (parietal cell mass and secretion)
Smoking impairs gastric mucosal healing
H. pylori produces toxins
Decreased inhibition of acid secretion possibly by H. pylori damaging somatostatin-producing cells in the antrum
More common in blood group O
What are gastric ulcers?
Associated with gastritis affecting the body as well as the antrum of the stomach
Parietal cell damage occurs so that acid production is normal or low
Local epithet damage by cytokines
What are the features of a duodenal ulcer?
Found in the duodenal cap
Surrounding mucosa is inflamed, haemorrhagic, friable
Pain classically occurs at night and is worse when hungry
Vomiting is infrequent but relieves pain
How is H. pylori diagnosed?
13C urea breath test
Serological tests detect IgG antibodies
Stool test
Endoscopy (rapid urease test, culture, histology)
What are the complications of a peptic ulcer?
Haemorrhage Perforation (DU more common, into peritoneal cavity) Pyloric stenosis or obstruction (projectile vomiting huge volumes)
What are other H. pylori associated diseases?
Gastric adenocarcinoma
Gastric B cell lymphoma
What causes gastropathy?
Epitheal/endothelial damage in the mucosa, little or no accompanying inflammation
Caused by aspirin, NSAIDs and alcohol use
What are the factors associated with adenocarcinoma of the stomach?
H. pylori Smoking Diets high in salt Pernicious anaemia Partial gastrectomy Japan
What are the clinical features of gastric cancer?
Occur in the antrum and usually adenocarcinomas Epigastric pain Nausea, anorexia, weight loss Vomiting (esp if tumour near pylorus) Dysphagia Anaemia Palpable epigastric mass with abdominal tenderness Virchow's node Dermatomyositis Acanthosis nigricans
What are the investigations done for carcinoma of the stomach?
FBC and liver biochemistry Gastroscopy and biopsy Barium meal (filling defect, irregular ulcer with rolled edges)
What are the causes of acute lower GI bleeding?
Ischameic colitis Carcinoma of caecum Polyps Diverticular Crohn's, UC Haemorrhoids Anal fissure Solitary ulcer of recur Meckel's diverticulum
What is the most commonest cause of chronic GI blood loss?
Hookworm
What are the features of a gastric volvulus?
Borchardt’s triad of severe epigastric pain, retching and inability to pass an NG tube
