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GI > Stomach pathology > Flashcards

Stomach pathology Flashcards

1
Q

What does dyspepsia mean?

A

describes a complex of upper GI symptoms which present for 4 or more weeks

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2
Q

What symptoms are included?

A

heart burn, coughing, sore throat (acid damages), dysphagia, nausea and vomiting

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3
Q

What are some common gastric disorders?

A 
GORD
Gastritis
Peptic ulcer disease
Zollinger-ellison disease
-Stress ulcers
-Cancer
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4
Q

What is GORD?

A

where the stomach contents moves into the oesophagus

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5
Q

What are the symptoms of GORD?

A

chest pain, acid taste in mouth, cough

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6
Q

What are the consequences of GORD?

A

nothing

  • oesophagitis
  • strictures
  • barrets oesophague (metaplasia of stratified squamous to simple columnar)
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7
Q

What can trigger GORD?

A
  • obesity (increased abdominal pressure)
  • pregnancy (new or worsened cases)
  • hiatus hernia (cardia of stomach moves into thorax reducing basal tone) HIGH RISK OF REFLUX OESOPHAGITIS
  • LOS function
  • delayed gastric emptying (increase in intra-gastric pressure)
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8
Q

What does the LOS consist of?

A
  • muscles
  • right crus of diaphragm
  • oblique entry of oesophagus into stomach
  • intra abdominal pressure
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9
Q

What is the treatment for GORD?

A

lifestyle modification (eat too fast/large meals/eat before bed)
pharmacological
-antacids (form layer of there acid)
-H2 antagonists (prevents histamine activating parietal cells)
-proton pump
surgery (RARE)

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10
Q

What is gastritis?

A

inflammation of the stomach (can be acute or chronic)

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11
Q

What are the of acute symptoms?

A

asymptomatic OR pain, nausea, vomiting, bleeding

-need to do endoscopy to see inflammation

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12
Q

What causes acute gastritis?

A
  • acute mucosal inflammatory processes
  • heavy use of NSAIDs
  • lots of alcohol
  • chemotherapy
  • bile reflux
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13
Q

Why does chemical injury cause inflammation?

A

exposure of mucosa to chemical injury causes damages to epithelial cells so less mucus is produced and the mucose responds by vasodilation and appearance of inflammatory cells (neutrophils)

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14
Q

What is the treatment for acute gastritis?

A

removal of the irritant

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15
Q

What causes chronic gastritis?

A
  • bacterial (H.pylori infection)

- autoimmune (antibodies to gastric parietal calles can lead to pernicious anaemia

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16
Q

What is pernicious anaemia?

A

a deficiency in the production of RBC due to lack of vitamin D

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17
Q

How does helicobacter-pylori cause inflammation?

A
  • releases cytotoxins which directly injure the epithelia

- expresses enzymes that form urease causing ammonium production which is toxic (converts urea to ammonium)

18
Q

How can you get h-pylori?

A

spread via oral to oral transmission or faecal to oral speak - has a flagellum to aids in motility
-also lives in mucus layer and adores to the gastric epithelia

19
Q

What type of bacteria is h-pylori?

A

helix shaped

gram negative

20
Q

What symptoms does someone with chronic gastritis caused by bacteria cause?

A
  • asymptomatic or similar to acute gastritis

- symptoms may develop due to complications (peptic ulcers, adenocarcinoma, MALT lymphoma)

21
Q

What occurs if H-pylori if found in the antrum (where G cells are) ?

A

there is increased gastrin secretion so increase parietal cell acid secretion - causes duodenal epithelial metaplasia and colonisation of duodenum causing a duodenal ulcer

22
Q

What occurs if H-pylori is found in the antrum and body?

A

asymtpomatic

23
Q

What occurs if H-pylori is found in the body?

A

-causes atrophy, gastric ulcer leading to intestinal metaplasia which can lead to dysplasia and then cancer

24
Q

How is H-pylori diagnosed?

A
  • urea breath test

- stool antigen test

25
Q

How is H-pylori treated?

A 
PPI
Amoxicillin and (clarithromycin or metronidazole)
26
Q

What are the symptoms of autoimmune cause of chronic gastritis?

A
  • anaemia symptoms
  • glossitis (inflammation of the tongue
  • anorexia
  • neurological symptoms
27
Q

What is peptic under disease?

A

occurs when there is a defect in the mucosa extending through the muscularis mucosa

28
Q

How does a peptic ulcer occur?

A
  • mucosal injury like H-pylori and NSAIDs
  • smoking (only can contribute to relapse of ulcer disease) and stress like burns
  • caused by the breakdown of normal defences rather than excessive acid e.g. reduced gastric emptying and inadequate acid neutralisation
29
Q

Where is the most common place for peptic ulcers?

A

-most common in the first part of the duodenum but often affects the lesser curve/antrum of stomach

30
Q

What is the difference between acute and chronic peptic ulcer disease?

A

acute ulcers develop as part of acute gastritis but chronic ulcers occur most frequently at mucosal junction where the antrum meets the body

31
Q

What are the clinical consequences of peptic ulcer disease?

A
  • scar tissue shrinking can narrow the stomach lumen
  • perforation can cause peritonitis
  • erosion can occur in to the adjacent structures (liver and pancreas)
  • Haemorrhage can occur from vessels in the base of the ulcer
  • malignancy is rare
32
Q

What are the symptoms of peptic ulcer disease?

A

-epigastric pain (as the stomach is a foregut structure)
-burning following meal times
-often at night
SOME MORE SERIOUS SYMPTOMS
-haematemesis or malaena(sticky dark faeces)
-early satiety from repeated scarring
-weight loss due to reluctance to eat due to pain

33
Q

How can you manage peptic ulcer disease?

A
  • lifestyle modification
  • stopping any exacrerbating medications
  • testing for H-pylori
  • PPI’s
  • endoscopy
34
Q

What is Zollinger-ellinson syndrome?

A

-non beta islet cell gastrin secreting tumour of the pancreas
-causes proliferation of parietal cells
(lots of acid production and severe ulceration of the stomach and small bowel)

35
Q

What are the symptoms of ZES?

A
  • abdominal pain

- diarrhoea

36
Q

What is stress related mucosal damage?

A

ba broad term used to describe the spectrum of pathology attributed to the acute erosive, inflammatory insult to the upper GI tract associated with critical illness

37
Q

When can stress related mucosal damage occur?

A
  • following multiple organ failure
  • sepsis
  • severe trauma
  • raised intracranial pressure
  • severe burns
38
Q

What are the symptoms of stomach cancer?

A
  • usually presents late
  • has to be quite large before symptoms
  • dysphagia
  • loss of appeptie
  • malaena
  • weight loss
  • mausea/vomiting
  • virchovs nodes
39
Q

What are the risk factors for stomach cancer?

A 
male
h-pylori
dietary factors
smoking
highest rates in japan/south America (they have screening programmes there)
40
Q

How is stomach pathology diagnosed?

A
  • endoscopy (can take biopsy to look for bacteria and tumours
  • urease breath test (release by H-pylori
  • Chest x-ray will show if the bowel is perforated by air being seen
  • blood test to look for anaemia
41
Q

How can stomach pathology be treated?

A
  • if caused by H-pylori, can give antibiotics
  • stop NSAISs
  • PPI
  • Histamine receptor (H2 blockers)

GI (10 decks)

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