Stomach Disorders Flashcards
Definition of Gastritis
Inflammation of stomach mucosa. Can be acute or chronic.
Definition of Autoimmune Gastritis
Aka atrophic gastritis. Inflammation of gastric mucosa, leading to destruction of gastric glandular cells and decreased secretion of HCl, pepsin and IF
Aetiology of Acute Gastritis
H pylori, NSAIDS/Aspirin, shock, stress, ETOH
Aetiology of Chronic Gastritis
H pylori, chem (NSAIDS, bile), radiation, Coeliac, infectious, granulomatous disorders
Pathophysiology of Acute Gastritis
- Prostaglandins, E2, and I2 stimulate protective mechanisms of stomach normally. NSAIDs disrupt COX1 and COX2
- Ischaemia, shock and increasing age affect secretion of bicarb and cell turnover
- Direct cellular injury
Pathophysiology of Chronic Gastritis
H pylori most common causative organism. Organisms concentrate on luminal surface of foveolar and mucus neck cells, may extend to gastric pit
Pathophysiology of Autoimmune Gastritis
Involves anti-bodies to parietal cells and intrinsic factor
Clinical Features of Gastritis
Non erosive: asymptomatic
Erosive: bleeding
Autoimmune: pernicious anaemia, B12 deficiency
Mx of Gastritis
- Avoid triggers: ETOH, NSAIDs< Trigger foods
- Manage underlying cause
- Eradication of H Pylori: ACE- amoxycillin, clairithomycin, esomeprazole
Definition of PUD
Focal deficits in mucosa that penetrate muscularis mucosal layer –> scarring
Includes defects in stomach (gastric ulcer) or duodenum (duodenal ulcer)
Aetiology of PUD
- H pylori
- NSAID use
- Stress
- Zollinger Edison Syndrome
- Crohn’s disease
- Idiopathic
Pathophysiology of PUD
Imbalance between protective factors (mucus bicarb layer, integrity of tight junctions, secretion of somatostatin) and aggressive factors (gastric juice, H Pylori, NSAIDs)
Clinical Features of PUD
May be asymptomatic. Main complaint is burning epigastric pain/discomfort +/- N/V, heartburn
If bleeding: Nausea, haematemesis, melena, hematochezia
If penetration/fistulisatiion: intense pain, halitosis, faeculant vomiting, weight loss
Perforation: sudden onset diffuse abdo pain, iron deficiency anaemia
Ix of PUD
Gold standard: endoscopy
Other important Ix:
- Urea breath test: to test for H Pylori infection
- Bloods: FBE, UEC
- Fasting serum gastrin levels (if suspect Zollinger Edison)
Mx of PUD
Lifestyle
- Weight loss - Diet - Stop smoking - Neutralise Acid: PPI - H Pylori eradication-
MEDICAL
- Triple Therapy (ACE)
- Amoxycillin
- Clarithomycin
- Esomeprazole
- Quadruple therapy (BTME sounds like bit me)
- Bismuth
- Tetracycline
- Metronidazole
- Esomeprazole
In case of perforated ulcer
- NPO (nil per os- nothing by mouth)
- URGENT ENDOSCOPY + Adrenaline (vasoconstriction, tamponade) + Thermal therapy (heater probe or gold probe) AND/OR Endoscopic clips
- IV fluid resus
- Surgery: indicated if profuse bleeding or initial tx unsuccessful
Ongoing medication: H pylori eradication, IV PPI (to reduce bleeding)
