Stomach conditions Flashcards
What are some examples of common gastric diseases?
Gastro-oesophageal reflux disease
Gastritis
Peptic ulcer disease
Stomach cancer
Zollinger-Ellison disease
What is gastro-oesophageal reflux disease?
Acidic contents of stomach move backwards up into oesophagus
What are the symptoms of gastro-oesophageal reflux disease?
Heartburn
Cough
Sore throat
What is the cause of gastro-oesophageal reflux disease?
Lower oesophageal sphincter dysfunction
What factors can contribute to gastro-oesophageal reflux disease?
Hiatus hernia
Obesity
What is hiatus hernia?
Herniation of cardia and fundus of stomach through oesophageal hiatus of diaphragm into thorax
What are the complications of gastro-oesophageal reflux disease?
Oesophagitis
Strictures
Barrett’s oesopheagus
What is oesophagitis?
Inflammation of lining of oesophagus
What is a stricture in the oesophagus?
Narrowing of oesophagus
What is Barrett’s oesophagus?
Metaplasia of stratified squamous epithelium lining the oesophagus to simple columnar epithelium
What is a complication of Barrett’s oesophagus?
Increased risk of developing adenocarcinoma
How is gastro-oesophageal reflux disease treated?
Lifestyle changes
Pharmacological
Surgery
What lifestyle changes are advised for gastro-oesophageal reflux disease?
Eat dinner earlier, not too soon before going to bed
Don’t go to sleep lying flat, lie slightly propped up
What drugs are given for gastro-oesophageal reflux disease?
Antacids
Proton pump inhibitors
H2 antagonists
What is an example of a common proton pump inhibitor drug?
Omeprazole
What are some examples of common H2 antagonists?
Cimetidine
Ranitidine
What is gastritis?
Inflammation of the lining of the stomach
What are the types of gastritis?
Acute gastritis
Chronic gastritis
What are the causes of acute gastritis?
Heavy use of NSAIDS
Lots of alcohol
How do NSAIDS cause acute gastritis?
Reduce prostaglandins in the stomach
reduce blood to flow to epithelial cells
reduced delivery of nutrients to those epithelial cells
more prone to damage, inflammation
How does alcohol cause acute gastritis?
Dissolves mucus layer of stomach
less protection of epithelial cells against acid of stomach
become damaged, inflamed
What are the symptoms of acute gastritis?
Pain
Nausea, vomiting
Maybe bleeding
What are the causes of chronic gastritis?
Infection with H.pylori
Autoimmune disease
How does helicobacter pylori spread from person to person?
Oral-oral route
Faecal-oral route
How does H.pylori colonise the stomach wall?
Adheres to epithelial cells
sits in the mucus layer lining the stomach
How does H.pylori damage stomach epithelial cells?
Releases cytotoxins
directly damage and kill epithelial cells
Produces urease
converts urea to ammonium
which is toxic to the epithelial cells
Breaks down mucus lining the stomach
reduced protection of epithelial cells from gastric acid
What are the symptoms of chronic gastritis caused by infection with H pylori?
Asymptomatic
or same symptoms as acute gastritis
or symptoms due to complications
What is the appearance of helicobacter pylori on a gram stain?
Gram negative
Helix shaped
Has a flagellum
What are the complications of chronic gastritis caused by infection with H pylori?
Peptic ulcers
Adenocarcinomas
How is infection with helicobacter pylori treated?
Triple therapy
- proton pump inhibitor
- clarithromycin
- amoxicillin
How does autoimmune disease cause chronic gastritis?
Autoantibodies against parietal cells in stomach
What are the symptoms of chronic gastritis caused by autoimmune disease?
Symptoms of anemia
Why does autoimmune disease causing chronic gastritis give symptoms of anaemia?
Destruction of parietal cells, which produce intrinsic factor
reduced intrinsic factor
reduced absorption of vitamin B12, vitamin B12 deficiency
red blood cells don’t mature
What is the name of the anaemia caused by autoimmune disease causing chronic gastritis?
Pernicious anaemia
What is a peptic ulcer?
Break in gastric or duodenal mucosa that extends through the muscularis mucosae, to the submucosa
Where are peptic ulcers most common?
Lesser curve of stomach
First part of duodenum
What are the causes of peptic ulcers?
NSAIDS
Infection with H pylori
Zollinger-Ellison disease
What are the symptoms of peptic ulcers?
Epigastric pain
occurs after meals
at night
Bleeding, anaemia
Satiety
What type of pain is felt with a peptic ulcer?
Burning pain
Why does peptic ulcer disease give early satiety?
Can lead to fibrotic repair in the stomach lining
causing adhesions
reduced capacity of stomach
What is Zollinger-Ellison disease?
Tumour in pancreas
produces excessive amounts of gastrin
proliferation of parietal cells in stomach, increased gastric acid production
damages epithelial cells in stomach, leading to peptic ulcers
What investigations are done for gastric diseases?
Upper GI endscopy
Biopsy
Urease breath test
Erect chest X ray
Blood count
Why is a biopsy done for gastric disases?
Because peptic ulcers and stomach cancer have a similar presentation
need to distinguish between the two
Why is an erect chest X ray done for gastric diseases?
In case an abdominal viscera has been perforated
leading to a pneumoperitoneum, air in the peritoneal cavity
in which case can see air under the diaphragm
Why is a blood count done for gastric diseases?
In case bleeding has occurred
leading to anaemia
What does H.pylori colonising the stomach pylorus lead to?
Stimulates G cells to produce more gastrin
more stomach acid secretion
duodenal ulceration
What is the oxygen tolerance of helicobacter pylori?
Survives in small amounts of oxygen
