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GI > Stomach pathologies > Flashcards

Stomach pathologies Flashcards

1
Q

What is dyspepsia?

A

Indigestion.

A general term used to describe upper GI symptoms, for example:
- upper abdominal pain or discomfort
- heartburn
- acid reflux
- n+v

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2
Q

What are the causes of dyspepsia?

A

Gastro-oesophageal reflux disease (GORD)
Peptic ulcer disease (PUD)
Upper GI malignancy
Functional dyspepsia

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3
Q

What are the risk factors of dyspepsia?

A
  • obesity
  • smoking
  • alcohol
  • diet -coffee, chocolate, spicy/fatty food, tomatoes
  • stress
  • anxiety
  • depression
  • medications: NSAIDs, corticosteroids, bisphosphonates
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4
Q

Management of dyspepsia?

A

Lifestyle management
- lose wt
- stop smoking
- reduce alcohol intake
- avoid trigger food
- counselling

Reduce or stop drugs that worsen the symptoms
- e.g. NSAID, aspirin

If recurrent or persistent symptoms:
- Switch tohistamine (H2)-receptor antagonist(H2RA).
- Consider long-term acid suppression therapy (PPI)

If symptoms persist despite optimal management in primary care →referral for endoscopy

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5
Q

What is GORD?

A

Acid from the stomach flowing up through thelower oesophageal sphincterand into the oesophagus, where it irritates the lining and causes symptoms.

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6
Q

What causes GORD?

A
  • impaired lower oesophageal sphincter (LES) resting tone
  • transient LES relaxations
  • delayed gastric emptying
  • increased intra-gastric pressure
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7
Q

What are the risk factors of GORD?

A
  • obesity
  • smoking
  • pregnancy
  • hiatal hernia (part of the stomach moves up to the chest)
  • diet -caffeine, alcohol, chocolate, spicy/fatty food, peppermint
  • stress
  • anxiety
  • medications -NSAIDs, corticosteroids, bisphosphonates
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8
Q

Complications of GORD?

A
  • oesophageal ulcerations
  • oesophagitis
  • oesophageal strictures
  • aspiration pneumonia
  • Barrett’s oesophagus
  • oesophageal cancer
  • oral conditions -dental erosions, gingivitis, halitosis
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9
Q

How does GORD present?

A
  • epigastric abdominal pain -burning, worse after meal and at night
  • regurgitations (food is coming up their oesophagus without vomiting)
  • globus sensation (something stuck in the throat)
  • hoarseness
  • dysphagia
  • chronic cough
  • n+v
  • sour/bitter taste
  • halitosis
  • may have epigastric tenderness to palpation
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10
Q

Treatment for GORD?

A

Lifestyle management
- lose wt
- stop smoking
- reduce alcohol intake
- avoid trigger foods
- smaller meals
- avoid food 3-4 hours before bed

Test for H. Pylori -can’t take PPI two weeks before the test.

Offering a full-dose PPI for 4 weeks for proven GORD, to aid healing.

Offering a full-dose PPI for 8 weeks for proven severe oesophagitis, to aid healing.

Recurrent symptoms -switch to H2RA (histamine (H2)-receptor antagonist)

Tx resistant -refer to endoscopy

Laproscopy

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11
Q

What is gastritis?

A

Inflammation of the stomach and presents with epigastric discomfort, nausea, and vomiting.

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12
Q

Causes of gastritis?

A
  • H. Pylori
  • NSAIDs
  • Excessive alcohol
  • Smoking
  • GORD
  • Stress ischaemia during critical illness
  • Autoimmune process (e.g. pernicious anaemia)
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13
Q

Complications of gastritis?

A
  • peptic ulcer disease (PUD)
  • gastric carcinoma
  • gastric lymphoma
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14
Q

How is gastritis diagnosed?

A

H. Pylori -stool antigen test or breath urea test

OGD (endoscopy)

Serum vitamin B12

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15
Q

How do acute and chronic gastritis present?

A

Acute gastritis:
- sudden onset epigastric pain, burning
- n+v
- may have epigastric tenderness

Chronic gastritis:
- epigastric pain
- n+v
- early satiety
- may have epigastric tenderness

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16
Q

How is gastritis treated?

A

Lifestyle management**
- stop smoking
- reduce alcohol intake
- smaller meals
- avoid NSAIDs

H. Pylori positive tx
- Triple therapy: PPI + amoxicillin + clarithromycin/metronidazole BD x7 days

H. Pylori negative tx
-PPI or H2RA

17
Q

What is peptic ulcer disease (PUD)?

A

Ulcer of the gastric or duodenal epithelium (mucosa).

18
Q

Risk factors of peptic ulcer disease?

A
  • H. Pylori
  • NSAIDs
  • mechanical ventilation
  • Zollinger-Ellision syndrome
19
Q

Complications of peptic ulcer disease?

A
  • haemorrhage
  • perforation
  • gastric outlet obstruction
20
Q

How is peptic ulcer disease diagnosed?

A
  • Test for H. Pylori -stool antigen test or breath urea test
  • OGD (endoscopy for pts acutely unwell)
  • 2ww referral if age 55 and over with wt loss and dyspepsia/reflux/upper abdominal pain
21
Q

How does peptic ulcer disease present?

A
  • epigastric pain, burning
    • worsened by eating = gastric ulcer
    • relieved by eating = duodenal ulcer
  • n + v
  • bloating
  • early satiety
  • melaena (dark black tar stool)
  • haemtemesis (vomiting blood)
  • wt loss
  • lightheadedness
  • weakness
  • +/- epigastric tenderness to palpation
  • signs of hypovolaemia (low extracellular fluid volume decreases cardiac output) if actively bleeding
    • increased HR
    • tachycardia
    • low BP
22
Q

How to distinguish between peptic and gastric ulcer disease?

A

Epigastric pain worsened by eating = gastric ulcer

Epigastric pain relieved by eating = duodenal ulcer

23
Q

Management and treatment of haemorrhaging in peptic ulcer disease?

A

Haemorrhaging = MEDICAL EMERGENCY

Includes other signs like haemtemesis, lightheadedness, or signs of hypovolaemia.

-Pt needs to go hospital
-Endoscopy -identify bleeding location
-Endoscopic clipping
-IV PPI (reduce inflammation)
-Discontinue NSAIDs
-Treat H. Pylori if present

24
Q

Treatment of peptic ulcer disease?

A

Lifestyle management
- stop smoking
- reduce alcohol intake
- smaller meals
- avoid NSAIDs (instead have paracetamol or COX-2 selective NSAID if necessary)

H. Pylori positive tx
-PPI for 8 wks, then start triple therapy.
-Triple therapy: PPI + amoxicillin + clarithromycin/metronidazole BD x7 days

H. Pylori negative tx
-PPI for 4-8wks

Repeat endoscopy to confirm healing 6-8 wks after starting tx.

Medical emergency -haemorrhaging →endoscopy, clipping, IV PPI, avoid NSAIDs, treat H. Pylori if present.

25
Q

What is gastric malignancy?

A

Stomach cancer, typically adenocarcinoma (cancer that forms in the glandular tissue).

26
Q

Risk factors of gastric malignancy?

A
  • H. Pylori
  • pernicious anaemia
  • N-nitroso compounds (cured meats)
  • diet low in fruits, vegetables
  • high salt diet
  • smoking
  • FHx
  • male sex
27
Q

How does gastric malignancy present?

A
  • upper abdominal pain
  • wt loss
  • loss of appetite
  • dysphagia
  • n + v
  • melaena (dark black tar stool)
  • +/- epigastric tenderness to palpation
  • lymphadenopathy
    • left supraclavicular node (Virchow’s node)
    • Periumbilical node (St Mary Joseph’s nodule)
28
Q

How is gastric malignancy managed?

A

-Surgical excision
-Radiation
-Chemotherapy

GI (12 decks)

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