Stomach Probs Flashcards
Clinical features of gastro-oesophageal reflux disease?
Heartburn (retrosternal chest pain) - particularly after eating, lying down, bending over, hot drinks
What is gastritis?
Inflammation of mucosa due to mucosal breakdown
Investigations for gastro-oesophageal reflux disease?
Only need to do them if there are alarming symptoms such as dysphagia, suspected hiatus hernia
Management of gastro-oesophageal reflux disease?
Lose weight Stop smoking Reduce alcohol Reduce foods know to aggravate it eg chocolate, fatty foods Antacids eg calcium carbonate Raft antacids eg Gaviscon PPIs eg omeprazole H2 antagonists eg ranitidine
What do PPIs do?
Reduce acid secretion by parietal cells
Complications of gastro-oesophageal reflux disease?
Barrett’s oesophagus
What is a peptic ulcer?
Break in superficial epithelial cells penetrating down into muscularis mucosa of either lower oesophagus, stomach or duodenum.
Causes of peptic ulcers?
NSAIDs
H. pylori
Smoking
Alcohol
How do NSAIDs cause peptic ulcers?
Inhibit production of prostaglandins which prevents production of the unstirred layer
How does smoking cause peptic ulcers?
Reduces prostaglandin synthesis
Epidemiology of peptic ulcers?
Found in 10% of adults
More common in men
Duodenal ulcers 2-3x more common than gastric
Clinical features of peptic ulcers?
Recurrent, burning epigastric pain which may be worse at night
Nausea and sometimes vomiting
Weight loss and anorexia
50% of patients are asymptomatic
Haematemesis if ulcer perforated blood vessels
When is pain worst with gastric ulcers and duodenal ulcers?
Gastric - worse when you eat (due to acid production)
Duodenal - worse when hungry
Investigations for peptic ulcers?
Stool test for presence of H. pylori Urea breath test Serum IgG a in blood sample Endoscopy in over 55s or if there are red flag symptoms to exclude cancer FBC for anaemia
Management of peptic ulcers of due to NSAIDs?
Stop/review their use - use an alternative
Prophylactic PPI as well ad NSAID
Treatment of peptic ulcers due to H pylori?
Triple therapy
- proton pump inhibitor (omeprazole)
- antibiotics - clarithromycin/amoxycillin
- H2 antagonist - cimetidine
Complications of peptic ulcers?
Haemorrhage of blood vessel due to erosion by the ulcer - leads to melena and haematemesis
Perforation of ulcer into peritoneal cavity
Gastric outlet obstruction - prepyloric, pyloric or duodenal
Which arteries are commonly eroded in peptic ulcers disease?
Gastric - splenic artery
Duodenal - gastroduodenal artery
How can an ulcer lead to gastric outlet obstruction?
How does it present?
When an active ulcer also has oedema
Or
Healing of an ulcer with associated fibrosis
Presents as vomiting without pain
Classify Helicobacter pylori
Gram negative
Spiral bacillus
How does H pylori survive in the stomach?
Expresses urease which produces ammonia from urea
This raises the pH in the surrounding locality, protecting it from stomach acid
How does H pylori cause excess acid production?
Lobes in crypts next to acid sensors of the stomach
Normal feedback mechanisms are altered due to the way H pylori raises local pH, so get excess acid production
How does H pylori cause inflammation?
Excess acid production
Releases vacA which can cause apoptosis of epithelial cells
How to diagnose H pylori?
IgG a detected in serum
13C urea breath test (13C urea -> NH3 + 13CO2)
Gastric sample taken by endoscopy and detect by culture of gastric mucosa
Stool test
