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GI > Week 5 - Gastric disease > Flashcards

Week 5 - Gastric disease Flashcards

1
Q

What is GORD?

A
  • Gastro-Oesophageal Reflux Disease

- Reflux of stomach contents into oesophagus

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2
Q

What are the symptoms of GORD?

A

-Heartburn, cough and wheeze, dysphagia, sore throat

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3
Q

What are the causes of GORD?

A
  • Lower Oesophageal sphincter problems
  • Delayed gastric emptying causing increased intragastric pressure
  • hiatus hernia = easier reflux
  • Obesity -> increased intragastric pressure
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4
Q

Name 3 complications of GORD

A
  • Oesophagitis
  • Strictures
  • Barretts Oesophagus
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5
Q

Why can oesopphagitis occur with GORD?

A

-Squamous cells of oesophagus intolerant to acid and inflammation occurs

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6
Q

What are the possible treatments of GORD?

A
  • lifestyle modifications

- Antacids, H2 antagonists and PPIs

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7
Q

State some causes of acute gastritis

A
  • Chronic NSAID use
  • Chronic alcohol abuse
  • Chemotherapy
  • Bile reflux
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8
Q

How does acute gastritis present?

A
  • Can be asymptomatic
  • N+V
  • Pain
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9
Q

State the common causes of chronic gastritis

A
  • Bacterial infection with H.pylori

- Autoimmune -> antibody to parietal cells

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10
Q

How can autoimmune antibodies to parietal cells lead to pernicious anaemia?

A
  • Destruction of parietal cells
  • Decreased intrinsic factor
  • Decreased vit b12 absorption
  • Pernicious anaemia
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11
Q

What are the symptoms of chronic gastritis caused by H.pylori?

A
  • Pain

- N+V

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12
Q

What are the symptoms of chronic gastritis caused by autoimmune?

A
  • Anaemia, glossitis, anorexia

- Neurological symptoms such as gait and numbness

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13
Q

What is peptic ulcer disease?

A

-Eroision of gastric/duodenal mucosa which extends through the muscularis mucosa

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14
Q

Where is a peptic ulcer most common?

A

-Superior duodenum before bile duct entry

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15
Q

Where is a gastric ulcer most common?

A

-Lesser curvature

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16
Q

When does a peptic/gastric ulcer occur?

A

-When there is mucosal injury or a breach i defences eg caused by increased acid, NSAIDs or H.Pylori

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17
Q

Do ulcers require treatment?

A

-They can be self-limiting or have drastic consequences

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18
Q

What are the symptoms of peptic/gastric ulcers?

A
  • Burning epigastric pain following meals/ at night (peptic)
  • Weight loss
  • Bleeding or anaemia
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19
Q

Which arteries are most likely eroded in gastric and peptic ulcers?

A
  • Gastric -> splenic

- Duodenal -> gastroduodnal

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20
Q

What is functional dyspepsia?

A
  • Symptoms with no physical evidence of disease

- Should only be diagnosed when everything else ruled out

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21
Q

How is gastric pathology diagnosed?

A
  • Endoscopy (with biopsy for H.pylori/cancer)
  • Urease breath test (urease produced by H.pylori0
  • CXR -> look for pneumoperitoneum
22
Q

What is pneumoperitoneum?

A

-Air under diaphragm

23
Q

How is H.pylori eradicated?

A

-PPi, Clarythromycin and amoxicillin

24
Q

What is zollinger-ellison disease?

A

-Non-beta islet cell gastrin secreting tumour of pancreas causing proliferation of parietal cells increasing acid production and causing severe ulceration of stomach and duodenum

25
Q

What can cause stress ulceration?

A
  • Severe burns
  • Raised ICP
  • Sepsis
  • Trauma/multiple organ failure
26
Q

How is H.pylori spread?

A
  • Feacal-oral

- Person-Person

27
Q

What is the gram status of h.pylori?

A

-Helical, gram negative bacteria

28
Q

What are the main virulence factors of H.pylori which allows it to survive in the stomach?

A
  • Produces urease to convert urea to ammonium -> Increases local pH by producing an alkali cloud ->Protects from acid and disrupts epithelium by degrading mucus layer
  • Uses chemotaxis to stay in alkali areas
  • Has flagella for motility
  • Releases cytotoxin for direct epithelial injury
29
Q

How does H.pylori cause ulceration of duodenum?

A
  • Colonisation in Antrum
  • Stimulates G cells to produce gastrin-> increased HCL causing duodenal epithelium metaplasia due to production of acid chyme
  • Colonisation of duodenal cap and duodenal ulceration
30
Q

Where is the most common place of colonisation in the stomach? What effect does colonisation have?

A
  • Body

- Atrophic effect on parietal cells which decreases acid production and can lead to gastric ulcers

31
Q

Where is colonisation with H.pylori least harmful?

A

-Antrum and body

32
Q

At what stage in its course does stomach cancer present?

A

-Usually late

33
Q

How does stomach cancer usually present?

A
  • Dysphagia
  • Loss of appetite
  • Malaena
  • Weightloss
  • N+V
  • Virchows nodes
34
Q

Where are virchows nodes and what are they associated with?

A
  • Above clavicle on LHS

- Stomach cancer

35
Q

Where,geographically, have high rate of stomach cancer?

A
  • Japan

- Chile

36
Q

What are risk factors for stomach cancer?

A
  • Male
  • H.pylori
  • Dietary factors
  • Smoking
37
Q

What is the main type of stomach cancer?

A

-Adenocarcinoma

38
Q

Besides adenocarcinoma, name 3 types of stomach cancer

A
  • Lymphoma
  • Carcinoid
  • Stromal
39
Q

How is stomach cancer diagnosed?

A

-Bloods, CT, endoscopy

40
Q

How is stomach cancer treated?

A

-Surgery, chemo, radiotherapy

41
Q

Give an example of a problem with LOS leading to GORD

A
  • Altered angle of entry

- Right crus of diaphragm not tight

42
Q

Why can hiatus hernia lead to GORD?

A

-Reflux of contents is easier

43
Q

What can cause bile reflux?

A

-Uncoordinated peristalsis in duodenum

44
Q

What are the normal defence mechanisms which must be breached in order for a peptic ulcer to occur?

A
  • Mucus
  • Bicarbonate
  • Adequate mucosal blood flow
  • Prostaglandins
  • Epithelial renewal
45
Q

Why does anaemia occur in peptic ulcer disease?

A

-Erousion through small blood vessel -> not big enough to cause haematemesis but enough to cause anaemia and malaena

46
Q

What does pneumoperitoneum indicate?

A

-Perforation

47
Q

List some common disorders of the stomach

A
  • GORD
  • Gastritis
  • Peptic Ulcer Disease
  • Zollinger-ellison
  • Stomach Cancer
48
Q

How common is dyspepsia?

A

-40% UK pop per year

49
Q

How common is stomach cancer?

A

-Third most common worldwide

50
Q

How are ulcers treated?

A
  • Antacids, H2 antagonist, PPIs
  • Eradicate H.pylori
  • Resection

GI (16 decks)

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