Stomach and Duodenum Flashcards
What is Menetrier’s disease
A rare condition presenting with weight loss and diarrhoea
What is Menetrier’s disease linked to
H pylori
What can be seen endoscopically in Menetrier’s disease
Hypertrophy of mucosal folds of the body and fundus
What is the treatment for Menetrier’s disease
To eradicate H pylori Reduce recretion (PPIs) Monitor endoscopically due to risk of gastric cancer
How are peptic ulcers caused
By an imbalance between luminal acid and mucosal defences
How are peptic ulcers distinct from erosions
They penetrate the muscularis mucosae
Are gastric ulcers usually benign or malifnant
Benign
What are 3 main causes of gastric ulcers
H pylori and NSAID use
Steroid and NSAID use
Stress
What are the clinical presentations of gastric ulcers
usually pain that is relieved on eating
What are some complications of a gastric ulcer
Haematemesis
perforation are commoner in the elderly
What are the clinical presentations of gastric ulcers
usually pain that comes on soon after eating
What are some complications of a gastric ulcer
Haematemesis
perforation are commoner in the elderly
What is the management for a peptic ulcer
Eradication of H pylori
4 weeks PPI
Smoking cessation and alcohol moderation
Stop NSAIDs if possible
When should surgery be considered in gastric ulcers
If there is haemmorhage
perforation
failure to heal or gastric outlet obstruction
What are the 4 main causes of a duodenal ulcer
H pylori
NSAID use
Smoking
Stress
Is perforation as a complication more common in gastric or duodenal ulcers
Gastric
What is the management of duodenal ulcers
Eradication of H pylori - routine use of PPI if there is haemorrhage
Smoking cessation
alcohol moderation
stop ulcerogenic drugs (NSAIDs and bisphosphonates)
What is the mortality rate for perforated ulcers
25%
What is the mortality rate for perforated ulcers
25%
What is the initial management for gastric outlet obstruction
Drip and suck - IV rehydration and NG aspiration
What is the later management for gastric outlet obstruction
Balloon dilatation or surgical resection
What is Zollinger-Ellison syndrome
A rare disorder with the triad of:
severe or recurrent peptic ulceration
Increased gastric acid secretion
Hypergastrinaemia due to a secretion from a non-beta cell islet pancreatic tumour
What often occurs with Zollinger-Ellison syndrome
Diarrhoea and steatorrhoea
What are the investigations for Zollinger-Ellison syndrome
Gastric acid secretion elevated and serum gastrin elevated
How is the cause investigated in Zollinger-Ellison syndrome
Endoscopic ultrasound or Oxtreoscan
What is the management for Zollinger Ellison syndrome
30% resectable
Lifelong PPI in high dose
Octreotide may help
What is gastroparesis
Delayed gastric emptying without mechanical obstruction
What are some characteristic of gastroparesis
recurrent vomiting
abdominal bloating
distension
What might help with gastroparesis
Peripherally acting antiemetics (domperidone)
What is indicated if malnutrition develops
Jejunostomy or parenteral nutrition
What is the most commonest cause of cancer death worldwide
Gastric carcinoma
Who is more likely to get gastric carcinoma
Men and those over 50
What are 6 causes of gastric carcinoma
Chronic H pylori infection
Familial: blood group A is associated
Genetic
Diet containing pickled or smoked foods, diets low in fruit and veg
Environment; smoking and alcohol
Rare, organic disorders; Menetrier’s disease and previous partial gastrectomy
What does adenocarcinoma develope from
Regions of intestinal metaplasia in the stomach which then develop secondary to chronic atrophic gastritis
What does early gastric cancer refer to
Adenocarcinoma confined to the mucosa or submucosa
What does early gastric cancer refer to
Adenocarcinoma confined to the mucosa or submucosa
What are the clincial features of gastric carcinoma
Epigastric pain
Loss of appetite
loss of weigh
haematemesis is rare
What is the investigation for the gastric carcinoma
Endoscopy - rolled irregular edged ulcers
What are some of the investigations for the complications of gastric carcinoma
Staging: FBC, LFT, CXR, Abdo CT, endoscopic US, laparoscopy
How is gastric cancer managed
Surgery: resection is only possible in a minority of cases and most surgery is palliative
Chemotherapy: Post op may improve survival and can also be used palliatively
How could prognosis of gastric cancer be improved
Public awareness and early diagnosis
Where is the most commonest site for non-nodal non-Hodgkin’s lymphoma
The stomach
What is MALT lymphoma
A B cell tumour caused by an immune response to chronic H pylori infection with cagA strains
Where do Gastrointestinal stromal tumours arise from
The interstitial cells of Cajal
