Upper GI disorders Flashcards
What are some of the symptoms of dyspepsia?
Epigastric pain/burning Early satiety and post-prandial fullness Belching Bloating Nausea Discomfort in the upper abdomen
What are the signs and symptoms of peptic ulcer disease?
recurrent, burning epigastric pain points with a single finger to epigastrium DU pain classically occurs at night relieved by antacids accompanied by nausea infrequently - vomitting which may relieve pain anorexia weight loss anaemia
Why is persistent, severe pain or pain radiating to the back a bad sign for patients with PUD?
It may indicate penetration to other organs
Back pain may suggest penetrating posterior ulcer to pancreas
List 3 differences between duodenal and gastric ulcers
- Pain of duodenal ulcers occurs 2-3 hours after eating
It is also immediately after for gastric ulcers - Duodenal ulcers are relieved by antacids
Gastric ulcers you get minimal relief through antacids - In duodenal ulcers patient’s tend to overeat
In gastric ulcers patients tend to under eat and lose weight
RF for peptic ulcer disease?
H pylori NSAIDs Smoking Bisphosphonates Burns - Curling ulcers Head trauma - Cushing ulcer
What is Helicobacter pylori?
Gram -ve rod,
Ix:
Stool antigen test
13C urea breath test
Tx: PPI + 2 antibiotics (triple therapy)
Recommend a triple therapy for the treatment of H. pylori
Omeprazole
Amoxicillin
Clarithyromycin
or if allergic to penicillin:
Omeprazole
Metronidazole
Clarithyromycin
What is the 13C-urea breath test and how do you improve its reliability?
Measure 13-CO2 in breath after ingestion of 13C-urea using a mass spectrometer
Improve outcome by:
Stopping any antibiotics in 4 weeks before test
No PPIs for 2 weeks before test
What is Zollinger-Ellison syndrome?
Neuroendocrine tumour - that secretes ectopic gastrin within the endocrine pancreas it accounts for 1 in 1000 cases of duodenal ulcer disease
Diagnosis: Elevated gastrin levels
What are the features of Zollinger-Ellison syndrome?
Involves a gastrin secreating neuroendocrine tumour that may be a part of multiple endocrine neoplasia -1
This gastrinoma secretes gastrin resulting in HYPERGASTRINAEMIA
Hypertrophy of the stomach mucosa and ulceration
This is turn leads to malabsorption as the stomach cannot absorb due to destruction
The gastrinoma also inactivates other pancreatic enzymes
When to suspect Zollinger-Ellison syndrome?
The patient gets recurrent ulceration which is not refractory to treatment
There is a family history of Multiple Endocrine Neoplasias
What are the Ix for Zollinger-Ellison syndrome?
Fasting serum gastrin Serum calcium Gastric acid secretory tests Stimulation tests Imaging
What is the management for Zollinger-Ellison syndrome?
PPI
Surgical resection if necessary
What is the prognosis for Zollinger-Ellison?
Good as long as not metastatic
What are the Ix for suspected peptic ulcer disease?
Patients under 55: Breath test, stool antigen (FBC, stool occult blood, serum gastrin)
Patient over 55, red flag, tx failed:
OGD, histology and biopsy if ulcer present, urease testing, Repeat OGD 6-8 weeks later
How do you manage PUD?
RF modification:
diet
quit smoking
stop NSAIDs and bisphosphonates
If H.pylori positive: Triple therapy - PPI + amoxicillin + clarithyromycin or metronidazole + clarithromycin
If H.pylori negative: PPI or H2 antagonist
What is the management for a bleeding peptic ulcer?
Endoscopy
- Treat (eg. treat varices with banding or stenting)
- ULCERS: Adrenaline + thermal coagulation or clipping
- Antral biopsy to look for H pylori
- Possible blood transfusion
What are the 3 complications of peptic ulcer disease?
Bleeding
Perforation
Gastric outlet obstruction
What is the management of perforated peptic ulcer?
NBM
IV antibiotics
Surgery
In patients who are elderly, frail, very sick - NG suction, IV fluids and abx can be use
List causes of gastric obstruction
Crohn’s
External compression due to pancreatic carcinoma
PUD
What is vomitting due to gastric obstruction like?
Infrequent
Projectile
Large in volume
Vomitus will contain particles from previous meals
