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GI and General Surgery > Stomach > Flashcards

Stomach Flashcards

1
Q

What is a hiatus hernia?

A

protrusion of stomach through oesophageal hiatus

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2
Q

What are the classifications of hiatus hernias?

A

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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3
Q

What are risk factors for hiatus hernias?

A

pregnancy
age
obesity
ascites

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4
Q

What are clinical features of a hiatus hernia?

A

asymptomatic
GORD symptoms
bleeding (secondary to oesophageal ulceration)

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5
Q

How are hiatus hernias diagnosed?

A

incidental finding

OGD

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6
Q

How are hiatus hernias managed?

A

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

surgical - fundoplication

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7
Q

What are indications for surgical management of a hiatus hernia?

A

nutritional failure
symptomatic despite maximum medical treatment
high risk of strangulation

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8
Q

What is dyspepsia?

A

epigastric pain or burning
post prandial fullness
early satiety

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9
Q

What are differentials for dyspepsia?

A 
functional dyspepsia 
oesophagitis
GORD
gastritis 
peptic ulcer disease
gastric cancer
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10
Q

What are investigations for dyspepsia?

A 
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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11
Q

What is a peptic ulcer?

A

break in mucosa of stomach or duodenum

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12
Q

When does a peptic ulcer occur?

A

imbalance between protective factors and damaging factors

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13
Q

What are GI mucosa defence mechanisms?

A

HCO3- ion release

surface mucous secretion

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14
Q

What are common causes of peptic ulcers?

A

H pylori

NSAIDS

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15
Q

Why do NSAIDs cause peptic ulcers?

A

inhibit prostaglandin secretion

decreased secretion of mucous, glycoprotein, phospholipids

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16
Q

What is H pylori?

A

gram negative spiral shaped bacillus

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17
Q

What are the clinical features of peptic ulcer disease?

A

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

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18
Q

When is pain worse in gastric ulcers?

A

worse after eating

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19
Q

What are red flag stomach symptoms?

A 
new onset dyspepsia unresponsive to PPI 
>55 + weight loss, abdo pain, dyspepsia 
new onset dysphagia 
epigastric mass 
anaemia
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20
Q

How is suspected peptic ulcer investigated?

A

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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21
Q

What are the H pylori tests?

A

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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22
Q

What is the management of peptic ulcer disease?

A

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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23
Q

What are complications of peptic ulcer disease?

A

pyloric stenosis
perforation
bleeding

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24
Q

How does a perforated ulcer present?

A

acute upper abdo pain, severe
systemically unwell
?vomiting

O/E: peritonism

25
Q

What is the gold standard investigation for a perforated ulcer?

A

CT scan - free air presence, location of perf

26
Q

How is a perforated ulcer managed?

A

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

27
Q

What is Zollinger Ellinson syndrome?

A

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

28
Q

What is associated with Zollinger Ellinson syndrome?

A

MEN Type 1

29
Q

How is Zollinger Ellinson syndrome diagnosed and managed?

A

fasting gastrin level >1000

high dose PPI

30
Q

What is the most common type of gastric cancer?

A

adenocarcinoma

31
Q

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

A

signet ring sign

32
Q

What are the types of gastric cancer?

A

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

33
Q

What can maltomas evolve into?

A

high grade B cell lymphoma

34
Q

What are the clinical features of gastric cancer?

A

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

35
Q

What may be found on examination in gastric cancer?

A

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

36
Q

How is gastric cancer diagnosed?

A

FBC - anaemia
urgent OGD + biopsy

CT CAP - staging

37
Q

How is gastric cancer managed?

A

surgery

  • subtotal or total gastrectomy
  • Roux en Y bypass afterwards

+ peri op chemo

38
Q

What are the complications of gastrectomy?

A

anastomotic leak
vitamin B12 deficiency
dumping syndrome

39
Q

How is palliative gastric cancer managed?

A

chemo and radiotherapy
stenting
NG tube

40
Q

What are risk factors for developing gastric cancer?

A

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

41
Q

What are the symptoms of gastroenteritis?

A 
sudden onset
crampy abdo pain 
N+V 
diarrhoea (+/- blood) 
fever, malaise, loss of appetite
42
Q

What is the most common bacterial gastroenteritis amongst travellers?

A

E. coli

43
Q

Describe the gastroenteritis caused by Giardiasis?

A

long, protracted travellers diarrhoea (non bloody)

weight loss, malabsorption

44
Q

Describe the gastroenteritis caused by Amoebiasis?

A

blood diarrhoea

45
Q

How is parasitic gastroenteritis treated?

A

metronidazole

46
Q

What bacteria is associated with rice?

A

Bacillus cerus

47
Q

How does Campylobacter typically present?

A

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

48
Q

What bacteria causes rice water stools?

A

Cholera

49
Q

Why do you get bloody diarrhoea in Shigella infection

A

haemorrhagic mucosa and ulceration in distal colon

50
Q

What bacteria causes haemolytic uraemic syndrome?

A

E. coli 0157

produces Shiga toxin

51
Q

How does HUS present?

A 
usually young children 
triad of:
- AKI
- haemolytic anaemia
- thrombocytopenia
52
Q

What is C. diff?

A

gram positive bacillus

53
Q

What antibiotics can cause C diff?

A

coamoxiclav
clindamycin
ciprofloxacin
cephalexin

54
Q

What produces symptoms in C diff?

A

release of exotoxins A and B

inflammatory response

55
Q

What are risk factors for C diff?

A 
prolonged hospital stay 
age 
surgery 
immunosuppression 
antibiotics
56
Q

How does C diff present?

A

sudden onset
crampy abdo pain
severe diarrhoea
raised WCC

57
Q

How is C diff diagnosed?

A

stool culture - C diff toxin (CDT)

58
Q

What is a complication of C diff infection?

A

toxic megacolon

59
Q

What is the treatment of C diff?

A

non severe - metronidazole 10 days

severe - vancomycin

GI and General Surgery (10 decks)

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