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GI > Stomach Disorders > Flashcards

Stomach Disorders Flashcards

1
Q

What symptoms comprise dyspepsia?

A
  • Epigastric pain or burning
  • Postprandial fullness
  • Early satiety
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2
Q

What factors make dyspepsia more common?

A

Helicobacter pylori infection or NSAID use

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3
Q

What diseases overlap with dyspepsia?

A

IBS and GORD

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4
Q

What are organic causes of dyspepsia?

A

Peptic ulcer disease, drugs (NSAIDs), gastric cancer

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5
Q

What is functional (idiopathic) dyspepsia?

A

The same as normal but with no evidence of structural disease

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6
Q

What will uncomplicated dyspepsia show on examination?

A

Epigastric tenderness

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7
Q

What will complicated dyspepsia show on examination?

A

Epigastric tenderness, cachexia, mass, evidence of gastric outflow obstruction, peritonism

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8
Q

What are the 3 steps of dyspepsia treatment?

A
  • Check H. pylori status
  • Eradicate if infected
  • If negative, treat with acid inhibition
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9
Q

As well as dyspepsia, what can a presenting complaint of ‘indigestion’ be?

A

Heartburn, or problems with other organs

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10
Q

What are alarm features when dealing with dyspepsia?

A

Dysphagia, GI blood loss, persistent vomiting, weight loss, upper abdominal mass

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11
Q

What should be done if alarm symptoms of dyspepsia are present in a patient?

A

Refer to a hospital specialist

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12
Q

What are the first line treatments for uncomplicated dyspepsia?

A

Lifestyle, antacids, histamine 2 receptor antagonists

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13
Q

If clearing H. pylori doesn’t clear symptoms, or there is no infection in the first place, how would you manage symptoms if the patient is aged <55?

A

Manage as functional dyspepsia

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14
Q

If clearing H. pylori doesn’t clear symptoms, or there is no infection in the first place, how would you manage symptoms if the patient is aged >55?

A

Consider referral to hospital specialist

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15
Q

What can inflammatory diseases of the stomach be known as?

A

Gastritis

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16
Q

What can cause acute gastritis?

A

Chemicals, burns, shock, severe trauma or head injury

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17
Q

What are common causes of gastritis?

A

ABC- autoimmune, bacterial, chemical

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18
Q

What are rarer causes or gastritis?

A

Lymphocytic, eosinophilic, granulomatous

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19
Q

How does the stomach look endoscopically in gastritis?

A

Red and inflamed

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20
Q

What causes autoimmune gastritis?

A

Anti-parietal and anti-intrinsic factor antibodies

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21
Q

What does autoimmune gastritis cause in the body of the stomach?

A

Atrophy and intestinal metaplasia

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22
Q

Which type of chronic gastritis cause pernicious anaemia?

A

Autoimmune

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23
Q

What does autoimmune gastritis increase risk of?

A

Malignancy

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24
Q

What is the most common type of chronic gastritis?

A

Bacterial (H. pylori)

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25
Q

Where does bacteria sit in bacterial gastritis?

A

On the epithelia of stomach cells which attracts neutrophils

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26
Q

Which interleukin is important in bacterial gastritis?

A

IL8

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27
Q

What does bacterial gastritis increase risk of?

A

Duodenal ulcer, gastric ulcer, gastric carcinoma/lymphoma

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28
Q

How is bacterial gastritis treated?

A

Antibiotics

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29
Q

What causes chemical gastritis and what does this result in?

A

NSAIDs, alcohol or bile reflux- causes direct injury to the mucus layer by fat solvents

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30
Q

What can chemical gastritis produce?

A

Erosions or ulcers

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31
Q

What will be shown on stomach microscopy in chemical gastritis?

A

Villiform epithelium (never normal in stomach)

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32
Q

What is gastroparesis?

A

Delayed gastric emptying- build up of food causes vomiting

33
Q

What are symptoms of gastroparesis?

A

Fullness, nausea, vomiting, weight loss, upper abdominal pain

34
Q

What can cause gastroparesis?

A

Idiopathic, diabetes mellitus, cannabis, opiates/anticholinerginics, systemic diseases

35
Q

What is the best test for gastroparesis?

A

Gastric emptying tests

36
Q

What are management options for gastroparesis?

A

Remove precipitating factor, liquid/sloppy diet, eat little and often, promotility agents, gastric pacemaker

37
Q

What is a temporary measure for gastroparesis?

A

Paralyse LOS with botox

38
Q

What is peptic ulceration?

A

A breach in GI mucosa as a result of acid and pepsin attack

39
Q

Where do peptic ulcers occur?

A

Stomach, first part of duodenum and end of oesophagus

40
Q

What does excess acid in the duodenum cause?

A

Gastric metaplasia, H. pylori, inflammation, epithelial damage, ulceration

41
Q

How does the stomach look (grossly) in peptic ulceration?

A

Punched out

42
Q

Microscopically in peptic ulceration, the stomach has a layered appearance. What makes up the floor, base and deep layer?

A

Floor- necrotic debris
Base- inflamed granulation tissue
Deep layer- fibrotic scar tissue

43
Q

What are complications of peptic ulcers?

A

Perforation, penetration, haemorrhage, stenosis, intractable pain, anaemia

44
Q

Where can peptic ulcer pain radiate?

A

Back

45
Q

With regards to timing, what can peptic ulcer pain be?

A

Nocturnal

46
Q

What can eating cause in peptic ulcer disease?

A

Aggravation or relieved pain

47
Q

What are causes of peptic ulcer disease?

A

H. pylori, NSAIDs, gastric dysmotility, outflow obstruction

48
Q

When are H. pylori infections acquired?

A

Infancy

49
Q

Describe H. pylori bacteria?

A

Gram - microaerophilic flagellated bacillus

50
Q

What is CagA?

A

Cytotoxin associated gene A- oncogenic and highly antigenic

51
Q

What tests can be used to detect H. pylori infection?

A

Gastric biopsy, urease test, histology, culture, urease breath test, faecal antigen test, serology

52
Q

What does H. pylori do to the pH of its environment?

A

Increases it

53
Q

What are the first two steps of management for peptic ulcer disease?

A

Anti-secretory therapies (PPIs), test for H. pylori

54
Q

What is the next step of treatment in PUD when a patient has H/ pylori?

A

Eradicate and confirm

55
Q

What is the next step of treatment in PUD when a patient is negative for H/ pylori?

A

PPIs, withdraw NSAIDs, lifestyle, improve nutrition, optimise co-morbidities

56
Q

What is the 1st line ‘triple therapy’ for H. pylori eradication?

A

PPI + amoxicillin 1g bd + clarithromycin 500mg bd for 1 week

57
Q

What is the 2nd line ‘triple therapy’ for H. pylori eradication?

A

PPI + metronidazole 400mg bd + clarithromycin 250mg bd for 1 week

58
Q

What is the advantage and disadvantage of 2 week therapy for H. pylori eradication?

A

Higher eradication but lower compliance

59
Q

What can be added to give quadruple therapy for H. pylori eradication?

A

Culture directed therapy

60
Q

What are common side effects of antibiotics for H. pylori eradication?

A

Nausea and diarrhoea

61
Q

Do uncomplicated duodenal ulcers require follow ups?

A

Not unless there are ongoing symptoms

62
Q

What do gastric ulcers require as follow up?

A

Endoscopy at 6-8 weeks to ensure healing and no malignancy

63
Q

What are examples of benign gastric tumours?

A

Hyperplastic polyps, cystic fundic gland polyps

64
Q

What are malignant gastric tumours?

A

Carcinomas (majority adenocarcinoma), non-Hodgkin’s lymphoma, gastro-intestinal stromal tumours

65
Q

What is the progression to gastric carcinoma?

A

H. pylori infection, chronic gastritis, intestinal metaplasia/atrophy, dysplasia, carcinoma

66
Q

What are other gastric premalignant conditions?

A

Pernicious anaemia, partial gastrectomy, Lynch syndrome, Menetrier’s disease

67
Q

What is Lynch syndrome?

A

Autosomal dominant condition which increases risk of cancers, specifically colorectal

68
Q

What is Menetrier’s disease?

A

Massive overgrowth of mucus cells in the mucus membrane of the stomach resulting in large gastric folds

69
Q

What do adenocarcinomas produce histopathologically?

A

Glands

70
Q

Where do gastric adenocarcinomas tend to metastasise?

A

Other organs, peritoneal cavity, ovaries, lymph nodes, liver

71
Q

What is the clinical presentation of gastric cancers?

A

Dyspepsia, upper GI haemorrhage, anaemia, weight loss, abdominal mass, anorexia/early satiety, vomiting

72
Q

What are palliative treatment options for gastric cancer?

A

Chemo or radiotherapy

73
Q

What are potentially curative treatment options for gastric cancer?

A

Surgery with or without NAC

74
Q

What factors shorten 5 year survival of gastric cancer?

A

Metastatic disease, short history advanced age, locally advanced lesion, superficial gross appearance

75
Q

What investigations would you do for gastric cancer?

A

Urgent upper GI endoscopy, colonoscopy

76
Q

What is acholridria and what does it cause?

A

Absence of HCl in gastric secretions- increases risk of gastric cancer

77
Q

What can cause acholridria?

A

Pernicious anaemia or previous gastric surgery

78
Q

What can H. pylori infection produce which reduces gastric acid?

A

IL-1beta

GI (17 decks)

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