Stomach Flashcards by Katie Bennett

What is a hiatus hernia?

protrusion of stomach through oesophageal hiatus

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What are the classifications of hiatus hernias?

rolling - ‘bubble’ of stomach in thorax

sliding - GOJ, abdo part of oesophagus and sometimes cardia of stomach slides through hiatus into thorax

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What are risk factors for hiatus hernias?

pregnancy
age
obesity
ascites

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What are clinical features of a hiatus hernia?

asymptomatic
GORD symptoms
bleeding (secondary to oesophageal ulceration)

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How are hiatus hernias diagnosed?

incidental finding

OGD

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How are hiatus hernias managed?

conservative - smoking cessation, weight loss, low fat/caffeine/alcohol diet, PPI

surgical - fundoplication

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What are indications for surgical management of a hiatus hernia?

nutritional failure
symptomatic despite maximum medical treatment
high risk of strangulation

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What is dyspepsia?

epigastric pain or burning
post prandial fullness
early satiety

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What are differentials for dyspepsia?

functional dyspepsia 
oesophagitis
GORD
gastritis 
peptic ulcer disease
gastric cancer

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What are investigations for dyspepsia?

bloods, FBC
H pylori testing
- stool antigen 
- carbon 13 urea breath test 
- serum antibodies 
OGD and biopsy of any ulcers 
- biopsy of stomach lining - rapid urease test for H pylori

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What is a peptic ulcer?

break in mucosa of stomach or duodenum

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When does a peptic ulcer occur?

imbalance between protective factors and damaging factors

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What are GI mucosa defence mechanisms?

HCO3- ion release

surface mucous secretion

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What are common causes of peptic ulcers?

H pylori

NSAIDS

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Why do NSAIDs cause peptic ulcers?

inhibit prostaglandin secretion

decreased secretion of mucous, glycoprotein, phospholipids

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What is H pylori?

gram negative spiral shaped bacillus

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What are the clinical features of peptic ulcer disease?

asymp.
dyspepsia - epigastric pain, early satiety, post pranidal fullness
nausea, bloating

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When is pain worse in gastric ulcers?

worse after eating

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What are red flag stomach symptoms?

new onset dyspepsia unresponsive to PPI 
>55 + weight loss, abdo pain, dyspepsia 
new onset dysphagia 
epigastric mass 
anaemia

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How is suspected peptic ulcer investigated?

FBC - anaemia?
H pylori testing
OGD + biopsy (if H pylori -ve or red flag symptoms)
- of ulcer (malignancy)
- of gastric lining (H pylori - rapid urease test)

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What are the H pylori tests?

non invasive

carbon 13 urea breath test
serum antibodies
stool antigen

invasive
- OGD + biopsy of stomach lining for rapid urease test

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What is the management of peptic ulcer disease?

H pylori eradication (triple therapy)

PPI +
amoxicillin + clarithromycin or metronidazole

conservative

smoking cessation, weight loss, decrease alcohol intake, avoid NSAIDs
PPI

surgery

rarely performed (except in perforation)
severe or relapsing disease
partial gastrectomy or selective vagotomy

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What are complications of peptic ulcer disease?

pyloric stenosis
perforation
bleeding

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How does a perforated ulcer present?

acute upper abdo pain, severe
systemically unwell
?vomiting

O/E: peritonism

What is the gold standard investigation for a perforated ulcer?

CT scan - free air presence, location of perf

How is a perforated ulcer managed?

A-E resus analgesia broad spectrum Abx surgery - omental patch repair and wash out

What is Zollinger Ellinson syndrome?

Neuroendocrine tumours - gastrinoma (produce gastrin, leads to gastric acid hypersecretion Leads to severe peptic ulcer disease

What is associated with Zollinger Ellinson syndrome?

MEN Type 1

How is Zollinger Ellinson syndrome diagnosed and managed?

fasting gastrin level >1000 | high dose PPI

What is the most common type of gastric cancer?

adenocarcinoma

What sign do you see on histology in diffuse gastric adenocarcinomas?

signet ring sign

What are the types of gastric cancer?

adenocarcinoma maltoma (gastric lymphoma) GISTS (gastrointestinal stromal tumours)

What can maltomas evolve into?

high grade B cell lymphoma

What are the clinical features of gastric cancer?

dyspepsia, unresponsive to PPI vomiting dysphagia non specific cancer symptoms (late disease)

What may be found on examination in gastric cancer?

Virchow's node (left supraclavicular) epigastric mass mets - hepatomegaly, ascites, jaundice

How is gastric cancer diagnosed?

FBC - anaemia urgent OGD + biopsy CT CAP - staging

How is gastric cancer managed?

surgery - subtotal or total gastrectomy - Roux en Y bypass afterwards + peri op chemo

What are the complications of gastrectomy?

anastomotic leak vitamin B12 deficiency dumping syndrome

How is palliative gastric cancer managed?

chemo and radiotherapy stenting NG tube

What are risk factors for developing gastric cancer?

partial gastrectomy H pylori (chronic gastritis) pernicious anaemia family history

What are the symptoms of gastroenteritis?

``` sudden onset crampy abdo pain N+V diarrhoea (+/- blood) fever, malaise, loss of appetite ```

What is the most common bacterial gastroenteritis amongst travellers?

E. coli

Describe the gastroenteritis caused by Giardiasis?

long, protracted travellers diarrhoea (non bloody) | weight loss, malabsorption

Describe the gastroenteritis caused by Amoebiasis?

blood diarrhoea

How is parasitic gastroenteritis treated?

metronidazole

What bacteria is associated with rice?

Bacillus cerus

How does Campylobacter typically present?

flu like prodromal illness crampy abdo pain, diarrhoea, blood association with GBS

What bacteria causes rice water stools?

Cholera

Why do you get bloody diarrhoea in Shigella infection

haemorrhagic mucosa and ulceration in distal colon

What bacteria causes haemolytic uraemic syndrome?

E. coli 0157 | produces Shiga toxin

How does HUS present?

``` usually young children triad of: - AKI - haemolytic anaemia - thrombocytopenia ```

What is C. diff?

gram positive bacillus

What antibiotics can cause C diff?

coamoxiclav clindamycin ciprofloxacin cephalexin

What produces symptoms in C diff?

release of exotoxins A and B | inflammatory response

What are risk factors for C diff?

``` prolonged hospital stay age surgery immunosuppression antibiotics ```

How does C diff present?

sudden onset crampy abdo pain severe diarrhoea raised WCC

How is C diff diagnosed?

stool culture - C diff toxin (CDT)

What is a complication of C diff infection?

toxic megacolon

What is the treatment of C diff?

non severe - metronidazole 10 days | severe - vancomycin