Stomach Probs

Question 0

Clinical features of gastro-oesophageal reflux disease?

Answer 0

Heartburn (retrosternal chest pain) - particularly after eating, lying down, bending over, hot drinks

Question 1

What is gastritis?

Answer 1

Inflammation of mucosa due to mucosal breakdown

Question 2

Investigations for gastro-oesophageal reflux disease?

Answer 2

Only need to do them if there are alarming symptoms such as dysphagia, suspected hiatus hernia

Question 3

Management of gastro-oesophageal reflux disease?

Answer 3

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

Question 4

What do PPIs do?

Answer 4

Reduce acid secretion by parietal cells

Question 5

Complications of gastro-oesophageal reflux disease?

Answer 5

Barrett’s oesophagus

Question 6

What is a peptic ulcer?

Answer 6

Break in superficial epithelial cells penetrating down into muscularis mucosa of either lower oesophagus, stomach or duodenum.

Question 7

Causes of peptic ulcers?

Answer 7

NSAIDs
H. pylori
Smoking
Alcohol

Question 8

How do NSAIDs cause peptic ulcers?

Answer 8

Inhibit production of prostaglandins which prevents production of the unstirred layer

Question 9

How does smoking cause peptic ulcers?

Answer 9

Reduces prostaglandin synthesis

Question 10

Epidemiology of peptic ulcers?

Answer 10

Found in 10% of adults
More common in men
Duodenal ulcers 2-3x more common than gastric

Question 11

Clinical features of peptic ulcers?

Answer 11

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

Question 12

When is pain worst with gastric ulcers and duodenal ulcers?

Answer 12

Gastric - worse when you eat (due to acid production)

Duodenal - worse when hungry

Question 13

Investigations for peptic ulcers?

Answer 13

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

Question 14

Management of peptic ulcers of due to NSAIDs?

Answer 14

Stop/review their use - use an alternative

Prophylactic PPI as well ad NSAID

Question 15

Treatment of peptic ulcers due to H pylori?

Answer 15

Triple therapy

• proton pump inhibitor (omeprazole)
• antibiotics - clarithromycin/amoxycillin
• H2 antagonist - cimetidine

Question 16

Complications of peptic ulcers?

Answer 16

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

Question 17

Which arteries are commonly eroded in peptic ulcers disease?

Answer 17

Gastric - splenic artery

Duodenal - gastroduodenal artery

Question 18

How can an ulcer lead to gastric outlet obstruction?

How does it present?

Answer 18

When an active ulcer also has oedema
Or
Healing of an ulcer with associated fibrosis

Presents as vomiting without pain

Question 19

Classify Helicobacter pylori

Answer 19

Gram negative

Spiral bacillus

Question 20

How does H pylori survive in the stomach?

Answer 20

Expresses urease which produces ammonia from urea

This raises the pH in the surrounding locality, protecting it from stomach acid

Question 21

How does H pylori cause excess acid production?

Answer 21

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

Question 22

How does H pylori cause inflammation?

Answer 22

Excess acid production

Releases vacA which can cause apoptosis of epithelial cells

Question 23

How to diagnose H pylori?

Answer 23

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

Question 24

What can gastritis lead to?

Answer 24

Hypergastrinaemia due to increased gastrin release from G cells
Increased acid production can lead to duodenal ulceration

Question 25

Where do gastric ulcers mostly affect?

Answer 25

Lesser curvature and pyloric antrum

Question 26

What type of cell loss can gastric ulcers lead to?

Answer 26

Parietal cell loss -> leads to reduced acid production

Question 27

How do PPIs such as omeprazole work?

Answer 27

Prevent H+ ions from being pumped into parietal cell canaliculi

Question 28

How do H2 antagonists reduce acid production?

Answer 28

Prevent histamine from acting on H2 receptors

Prevent amplification effects of gastrin and Ach which can act directly on the parietal cell and through histamine

Question 29

Which vertebral levels does the stomach extend from and to?

Answer 29

T7-L3

Question 30

What is dyspepsia?

Answer 30

A variety of symptoms including

• upper abdominal pain
• heartburn
• acid reflux
• nausea
• vomiting

Question 31

How is the urease breath test done to detect H pylori?

Answer 31

Patient swallows radioactively labelled urea

20mins later, if you can detect radio-actively labelled CO2, shows that H pylori is present

Question 32

Name a PPI

Answer 32

Omeprazole

Question 33

Name antibiotics used to treat H pylori

Answer 33

Amoxycillin
Clarithromycin
Metronidazole

Question 34

Example of a H2 antagonist

Answer 34

Cimetidine