Stomach Disorders Flashcards
What is Gastritis?
Inflammation of the gastric mucosa, which can be acute or chronic
Inflammation of the stomach
What are the two types of Gastritis?
Acute Gastritis caused by H. pylori infection, NSAIDs, alcohol, severe stress, bile reflux which often presents with epigastric pain, nausea, and vomiting.
Chronic Gastritis which can be caused by Autoimmune (Type A)→ Antibodies against parietal cells → Pernicious anaemia is associated with increased gastric cancer risk.
Chronic gastritis can also be caused by H. pylori-associated (Type B)→ Affects antrum → ↑ risk of PUD & gastric cancer, which is common worldwide.
What are the common symptoms of Gastritis?
Epigastric pain, nausea, vomiting, bloating, early satiety
What are the investigations for Gastritis?
Investigations: H. pylori tests: Urea breath test, stool antigen, biopsy
Endoscopy: Mucosal erythema, erosions
FBC: Check for anaemia
What is the management of Gastritis?
Treat Underling cause
H. pylori eradication:PPI + Amoxicillin + Clarithromycin for 7–14 days)
Stop offending agents(NSAIDs, alcohol)
PPIs (Omeprazole)orH2 blockers (Ranitidine)
Vitamin B12 supplements(if autoimmune gastritis)
What are some facts related to Gastritis?
- NSAIDs inhibit prostaglandins, which maintain the stomach’s protective mucus—leading to gastritis.
- H. pylori survives in stomach acidby producingurease, which converts urea into ammonia, neutralizing acid.
- Gastritis doesn’t always cause pain!Many patients areasymptomaticbut still at risk for complications.
What is Helicobacter Pylori?
Helicobacter pylori is a Gram-negative, spiral-shaped, flagellated bacterium that colonises the gastric mucosa.
It is a common cause of peptic ulcer disease (PUD) and is associated with chronic gastritis, gastric cancer, and MALT lymphoma.
It thrives in the acidic environment of the stomach by producing urease, an enzyme that breaks down urea into ammonia, neutralising stomach acid.
What are the clinical features of H-pylori?
Asymptomatic in most people (over 50% of the world’s population is infected).
Symptoms:
1. Epigastric pain (burning or gnawing, worse on an empty stomach).
2. Dyspepsia (bloating, nausea).
3. Peptic ulcers (gastric or duodenal).
4. Complications: GI bleeding, perforation, gastric malignancy.
What are Non-invasive tests for H-pylori?
- Urea breath test (detects CO₂ after urea breakdown).
- Stool antigen test (detects H. pylori proteins).
What are the invasive tests?
If endoscopy indicated:
1. Rapid urease test (biopsy-based).
2. Histology (gold standard).
Culture & PCR (less common).
What is the first line treatment of the management of H-pylori?
- Offer people who test positive for H pylori a 7-day,twice-dailycourse of treatment with:
- a PPI (e.g. lansoprazole 30mg, omeprazole 20-40mg) and amoxicillin 1g and
either clarithromycin 500mg or metronidazole 400mg. - Offer people who are allergic to penicillin a 7-day,twice-dailycourse of treatment with:
- a PPI (e.g. lansoprazole 30mg, omeprazole 20-40mg) and
clarithromycin 250mg and
metronidazole 400mg - Offer people who are allergic to penicillin and who have had previous exposure to clarithromycin a 7-day,twice-dailycourse of treatment with:
- a PPI (e.g. lansoprazole 30mg, omeprazole 20-40mg) and
bismuth and
metronidazole 400mg and
tetracycline 500mg
What is the second line treatment for the management of H-pylori?
Offer people who still have symptoms after first-line eradication treatment a 7-day,twice-dailycourse of treatment with:
- a PPI and
amoxicillin 1g bd and
either clarithromycin 500mg bd or metronidazole 400mg bd (whichever was not used first-line)
Offer people who have had previous exposure to clarithromycin and metronidazole a 7-day,twice-dailycourse of treatment with:
- a PPI and
amoxicillin 1g and
a quinolone or tetracycline 500mg
Offer people who are allergic to penicillin (and who have not had previous exposure to a quinolone) a 7-day,twice-dailycourse of treatment with:
- a PPI and
metronidazole 400mg and
levofloxacin 250mg
Offer people who are allergic to penicillin and who have had previous exposure to a quinolone:
- a PPI and bismuth and
metronidazole 400mg and
tetracycline 500mg
Seek advice from a gastroenterologist if eradication of H pylori is not successful with second-line treatment
What is Peptic Ulcer disease?
Peptic Ulcer Disease (PUD) refers to the development of sores or ulcers in the lining of the stomach (gastric ulcers), small intestine (duodenal ulcers), or the oesophagus (oesophageal ulcers). These ulcers are typically caused by the breakdown of the protective mucosal layer, which exposes the underlying tissue to stomach acid and digestive enzymes.
What are the two types of Peptic Ulcers?
Gastric Ulcer which is caused by H. pylori (70%), NSAIDs, smoking, stress. The pain worsens with food.
Duodenal Ulcer which is caused by H. pylori (90%), NSAIDs, Zollinger-Ellison Syndrome. The pain is relived by food.
What are the symptoms of PUD?
Symptoms: Burningepigastric pain, nausea, bloating, early satiety, nocturnal pain
Red flag symptoms: Unintentionalweight loss,anaemia, vomiting blood (haematemesis)
What are the investigations for PUD?
- H. pylori testing(urea breath test, stool antigen)
- Endoscopy(gold standard,biopsy if gastric ulcerto rule out cancer)
- FBC(check for anaemia),faecal occult blood test
What is the management of PUD?
- H. pylori eradication therapy(PPI + Amoxicillin + Clarithromycin) or PAM.
- PPIs (Omeprazole, Lansoprazole)for ulcer healing
- Stop NSAIDs, alcohol, smoking.
- Surgery (rare): If complications like perforation or obstruction.
What is pyloric stenosis?
Narrowing of the pyloric sphincter due tohypertrophyof the pyloric muscle, leading togastric outlet obstruction.
It is caused by:
1. Infantile (Congenital) Pyloric Stenosis(most common)
2. Acquired pyloric stenosis:
- Chronic PUD(scarring)
- Gastric cancer
What are the symptoms and diagnosis of Pyloric stenosis?
Infants
Symptoms:
Projectile,non-bilious vomiting, dehydration, weight loss
Exam Findings:
Olive-shaped massin epigastrium
Investigations:
US abdomen→ Thickened pyloric muscle
Adults
Symptoms:
Early satiety, nausea, bloating,postprandial vomiting
Exam findings:
Succussion splash on auscultation
Investigations:
Endoscopy, Barium swallow
How is pyloric stenosis managed?
IV fluids + electrolyte correction
Definitive surgery:
Ramstedt’s pyloromyotomy(for infants),
Endoscopic dilation (for adults)
PPIsif secondary to ulcer scarring
What are gastric neoplasms?
Gastric neoplasms refer toabnormal growths in the stomach, which can bebenign or malignant.
The most common malignant gastric neoplasm isgastric adenocarcinoma, but there are also other types likegastrointestinal stromal tumours (GISTs)andlymphomas.
What are the different types of gastric neoplasms?
Gastric Adenocarcinoma (90%):
Most common malignant tumour of the stomach
Gastrointestinal Stromal Tumours (GISTs):
Arise from interstitial cells of Cajal, often found in the stomach
MALT Lymphoma:
Associated withH. pylori infection, can regress with eradication therapy
Neuroendocrine Tumours (Carcinoid):
Arise from enterochromaffin cells, can secrete serotonin
Benign Gastric Polyps:
Non-cancerous but may have malignant potential
What are the risk factors of gastric neoplasms?
Diet:
High salt intake, smoked foods, pickled vegetables, nitrates
Low fruit & vegetable consumption
Infections & Medical History:
H. pylori infection(major risk factor)
Chronic atrophic gastritis & intestinal metaplasia
Previous gastric surgery (e.g., Billroth II resection)
Lifestyle & Genetic Risks:
Smoking & Alcohol
Family history of gastric cancer
Genetic syndromes (e.g., Lynch syndrome, CDH1 mutation in hereditary diffuse gastric cancer)
What are the symptoms of gastric neoplasms?
Often asymptomatic until late stage!
Persistent epigastric pain(dull, vague)
Unintentional weight loss
Early satiety (feeling full quickly)
Dysphagia(if tumour is near gastroesophageal junction)
Nausea, vomiting, bloating
Iron-deficiency anaemia(due to chronic bleeding)
What are the red flag symptoms of gastric neoplasms/cancer?
Require urgent referral
Dysphagia
Unexplained weight loss
Persistent vomiting
Palpable epigastric mass
Overt gastrointestinal bleeding (haematemesis/melena)
How are gastric neoplasms/ cancer diagnosed?
- Clinical suspicion and alarm symptoms (abdominal exam + history)
- Upper GI endoscopy and biopsy which is gold standard
- Staging investigations:
CT scan (chest/abdomen/pelvis)– checks for metastasis
PET-CT– detects distant spread
Endoscopic Ultrasound (EUS)– determines depth of invasion
Laparoscopy– used for staging
What is the management of gastric cancer?
Early Gastric Cancer (Confined to Mucosa/Submucosa):
Endoscopic Resection(if no lymph node involvement)
Locally Advanced Disease (Involving Muscularis Propria or Beyond):
Surgical Resection (Total or Partial Gastrectomy)
Lymph Node Dissection
Adjuvant Therapy (Before or After Surgery):
Chemotherapy(e.g., FLOT regimen – 5-FU, Leucovorin, Oxaliplatin, Docetaxel)
Targeted Therapy:HER2+ tumours →Trastuzumab
Immunotherapy:PD-L1 positive tumours →Nivolumab
Palliative Care for Metastatic Disease:
Palliative chemotherapy
Stent placementfor gastric outlet obstruction
Pain & symptom management
