The Stomach Flashcards
Peptic ulcers causes
Age Female H.pylori NSAIDS Smoking Alcohol Bile acids Steroids Stress Hyperchlorydia Hyper parathyroid Genetics Cancer
Peptic ulcer pathophysiology
H.pylori:
- initiates inflammation in gastric mucosa
- excess acid-pepsin production -> hypergastrinemia
Acid-pepsin production:
- exaggerated gastrin response to food
- increased acid-pepsin production
Mucosal resistance:
- mucosal atrophy with age-> secrete less bicarbonate
- mucosal irritation -> alcohol, aspirin, NSAIDS
Smoking:
-gastric mucosal ischaemia
Peptic ulcer symptoms
Epigastric pain-> gnawing/burning
Indigestion
Heartburn
Dysphagia
Gastric ulcer-> pain on eating
- vomiting
- acute GI bleed
- anorexia
- wt loss
- anaemia
Duodenal-> pain when hungry
- episodes of remission
- often gain weight
Epigastric tenderness
Hypokalemia
Peptic ulcer investigations
Oesophageal-gastro-duodenoscopy
Biopsy and brush
-> repeat
Peptic ulcer management
Regime to eradicate h.pylori-> metronidazole, PPI, amoxicillin
H2receptor antagonists
Peptic ulcer complications
May penetrate gastro duodenal artery if posterior
Peritonitis if anterior
Gastric outflow obstruction
Gastro colic fistula
Gastric CA risk factors
H.pylori Male 50-70y High nitrate intake Smoking Genetics FH Perinicious anaemia Gastric op for peptic ulcer
Gastric CA clinical features
Often asymptomatic till advanced Wt loss Epigastric pain Nausea Anorexia Early satiety Frequent vomiting Dysphagia Haematemesis Meleana Gastric outlet obstruction Malignant ascites Palpable mass Virchows node
Gastric CA investigations
Endoscopy and biopsy
CT and PET staging
Laparoscopy
Gastric CA management
Curative:
- surgical resection
- 39-40% of cases
- +chemotherapy
Palliative:
- surgery to relieve symptoms
- bypass
- laser ablation
- stent
- chemotherapy
