Week 5 - Pathophysiology Of Gastric Disease

Question 1

What is dyspepsia?

Answer 1

Heart burn/indigestion for 3 or more months

Question 2

What is gastro-oesophageal reflux disease (GORD)?

Answer 2

Reflux of stomach contents into oesophagus

Question 3

What are the symptoms of GORD?

Answer 3

Heartburn
Cough
Sore throat
Disphagia

Question 4

What are the main causes of GORD?

Answer 4

Lower esophageal sphincter problems
Delayed gastric emptying
Hiatus hernia
Obesity

Question 5

Why does delayed gastric emptying cause GORD?

Answer 5

Because it causes raised intra-gastric pressure

Question 6

What is a hiatus hernia?

Answer 6

Lower esophageal sphincter goes into thorax

Question 7

What Robles does GORD cause?

Answer 7

Oesophagitis
Strictures
Barrett’s oesophagus

Question 8

What is Barrett’s oesophagus?

Answer 8

Metaplasia of squamous epithelium of oesophagus to columnar

Question 9

What complications may occur due to Barrett’s oesophagus?

Answer 9

Adenocarcinoma

Question 10

How is GORD treated?

Answer 10

Lifestyle modifications
Pharmacologically - antacids, H2 antagonists, proton pump inhibitors (PPIs)
Surgery (rare)

Question 11

What surgery is performed to treat GORD?

Answer 11

Wrap fundus of stomach around to support lower oesophageal sphincter

Question 12

What is acute gastritis?

Answer 12

Acute mucosal inflammation of stomach

Question 13

What may cause acute gastritis?

Answer 13

Heavy use of NSAIDs
Lots of alcohol - dissolves mucous layer
Chemotherapy - affects highly proliferating cells
Bile reflux

Question 14

What are the symptoms of acute gastritis?

Answer 14

Asymptomatic or
Pain
Nausea
Vomiting
Occasionally bleeding - may be fatal

Question 15

What may cause chronic gastritis?

Answer 15

Bacterial - H-Pylori (most common cause)
Autoimmune - antibodies to gastric parietal cells
Chemical/reactive - chronic alcohol abuse, NSAIDs, reflux of bile

Question 16

What would the symptoms of chronic gastritis caused by H-pylori be?

Answer 16

Asymptomatic or similar to acute gastritis

Other symptoms may develop due to complications such as peptic ulcers and adenocarcinoma

Question 17

Why might complications with chronic gastritis occur?

Answer 17

Not as protective against acid as mucous secreting cells are inflamed

Question 18

What would the symptoms of chronic gastritis caused by autoimmune response be?

Answer 18

Symptoms of Angelia, gloss it is (inflammation of tongue), anorexia, neurological symptoms

Question 19

What are peptic ulcers?

Answer 19

Defects in gastric/duodenal mucosa extending though the muscular is mucosa

Question 20

Were are peptic ulcers most commonly found?

Answer 20

Most commonly in first part of duodenum

Also commonly found in lesser curve of stomach

Question 21

What is the cause of peptic ulcers?

Answer 21

Mucosal injury due to stomach acid, H-pylori, NSAIDs, smoking (only really contributes to relapse of ulcer disease), massive physiological stress e.g. Burns

Question 22

What are the symptoms of peptic ulcers?

Answer 22

Epigastric pain - burning/gnawing pain
Following meal times if stomach
At night if duodenal
Bleeding/anaemia
Satiety early (feeling full)
Weight loss

Question 23

What is functional dyspepsia?

Answer 23

Symptoms of ulcer disease but no physical evidence

Question 24

How can H-pylori be detected?

Answer 24

Urease breath test

Question 25

How does a urease breath test work?

Answer 25

H-pylori breaks down urea which increases surrounding pH Give patient radiolabel If CO2 given off on breath the H-pylori present

Question 26

How are peptic ulcers treated?

Answer 26

Eradicate H-pylori - PPI, clarithromycin, amoxicillin Stop NSAIDs Endoscopy for bleeding ulcers PpIs

Question 27

What are the most common H2 blockers used?

Answer 27

Cimetidine | Ranitidine

Question 28

What is the he most common proton pump inhibitor?

Answer 28

Omeprazole

Question 29

How is H-pylori spread?

Answer 29

Oral to oral | Faecal to oral

Question 30

Describe what type of bacteria H=pylori is?

Answer 30

Helix shaped Gram negative Microaerophillic

Question 31

What does urease do?

Answer 31

Converts yea to ammonium which is basic in solution so increases the local pH around the bacteria

Question 32

How does the H-pylori cause problems?

Answer 32

Releases cytotoxins Expresses enzymes Possibly degrades mucous layer Promotes inflammatory response

Question 33

How does promoting an inflammatory response cause injury?

Answer 33

Causes self injury

Question 34

How do cytotoxins cause damage?

Answer 34

Direct epithelial injury

Question 35

Where in the stomach is H-pylori usually found?

Answer 35

The antrum

Question 36

If H-pylori are colonising the antrum and the body of the stomach what will the symptoms be?

Answer 36

Asymptomatic

Question 37

If H-pylori is only colonising the stomach what will the symptoms be?

Answer 37

Its where most of the G cells are located so there will be an increase in gastrin secretion which will cause increase in parietal cells acid secretion This may cause duodenal epithelial metaplasia, colonisation of duodenum, duodenal ulceration

Question 38

If H-pylori are predominantly colonising the body of the stomach what will the symptoms be?

Answer 38

Will have an atrophic affect cause in gastric ulcers and intestinal metaplasia which may lead to cancer

Question 39

What is zollinger-ellison syndrome?

Answer 39

A non beta islet cell gastrin secreting tumour of the pancreas Causes proliferation of parietal cells, this means lots of acid produced and causes severe ulceration of the stomach and small bowel

Question 40

What are the symptoms of Zollinger-Ellison syndrome?

Answer 40

Abdominal pain, diarrhea

Question 41

What may cause stress peptic ulcers?

Answer 41

``` Severe burns raised intercranial pressure Sepsis Severe trauma Multiple organ faliure ```

Question 42

What are the symptoms of stomach cancer?

Answer 42

``` Presents late, has to be quite large before symptoms arise Diphagia Loss of appetite Malaena Weight loss Nausea Vomiting Virchow's nodes ```

Question 43

What is melaena?

Answer 43

Iron in blood is oxidised causing stool to be black

Question 44

What areas of the world is stomach cancer most common and why?

Answer 44

Chile, japan, South America | Their diets predispose them to it

Question 45

What are the risk factors for stomach cancer?

Answer 45

Male H-pylori Dietary factors Smoking