Stomach pathologies Flashcards
What is dyspepsia?
Indigestion.
A general term used to describe upper GI symptoms, for example:
- upper abdominal pain or discomfort
- heartburn
- acid reflux
- n+v
What are the causes of dyspepsia?
Gastro-oesophageal reflux disease (GORD)
Peptic ulcer disease (PUD)
Upper GI malignancy
Functional dyspepsia
What are the risk factors of dyspepsia?
- obesity
- smoking
- alcohol
- diet -coffee, chocolate, spicy/fatty food, tomatoes
- stress
- anxiety
- depression
- medications: NSAIDs, corticosteroids, bisphosphonates
Management of dyspepsia?
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
What is GORD?
Acid from the stomach flowing up through thelower oesophageal sphincterand into the oesophagus, where it irritates the lining and causes symptoms.
What causes GORD?
- impaired lower oesophageal sphincter (LES) resting tone
- transient LES relaxations
- delayed gastric emptying
- increased intra-gastric pressure
What are the risk factors of GORD?
- 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
Complications of GORD?
- oesophageal ulcerations
- oesophagitis
- oesophageal strictures
- aspiration pneumonia
- Barrett’s oesophagus
- oesophageal cancer
- oral conditions -dental erosions, gingivitis, halitosis
How does GORD present?
- 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
Treatment for GORD?
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
What is gastritis?
Inflammation of the stomach and presents with epigastric discomfort, nausea, and vomiting.
Causes of gastritis?
- H. Pylori
- NSAIDs
- Excessive alcohol
- Smoking
- GORD
- Stress ischaemia during critical illness
- Autoimmune process (e.g. pernicious anaemia)
Complications of gastritis?
- peptic ulcer disease (PUD)
- gastric carcinoma
- gastric lymphoma
How is gastritis diagnosed?
H. Pylori -stool antigen test or breath urea test
OGD (endoscopy)
Serum vitamin B12
How do acute and chronic gastritis present?
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
How is gastritis treated?
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
What is peptic ulcer disease (PUD)?
Ulcer of the gastric or duodenal epithelium (mucosa).
Risk factors of peptic ulcer disease?
- H. Pylori
- NSAIDs
- mechanical ventilation
- Zollinger-Ellision syndrome
Complications of peptic ulcer disease?
- haemorrhage
- perforation
- gastric outlet obstruction
How is peptic ulcer disease diagnosed?
- 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
How does peptic ulcer disease present?
- 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
How to distinguish between peptic and gastric ulcer disease?
Epigastric pain worsened by eating = gastric ulcer
Epigastric pain relieved by eating = duodenal ulcer
Management and treatment of haemorrhaging in peptic ulcer disease?
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
Treatment of peptic ulcer disease?
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.
What is gastric malignancy?
Stomach cancer, typically adenocarcinoma (cancer that forms in the glandular tissue).
Risk factors of gastric malignancy?
- H. Pylori
- pernicious anaemia
- N-nitroso compounds (cured meats)
- diet low in fruits, vegetables
- high salt diet
- smoking
- FHx
- male sex
How does gastric malignancy present?
- 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)
How is gastric malignancy managed?
-Surgical excision
-Radiation
-Chemotherapy
