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year 1 > GI - stomach > Flashcards

GI - stomach Flashcards

1
Q

what is GORD

A

reflux of acid and bile from stomach due to reduced LOS tone
can also be caused by
=> reduced barrier function
=> increased visceral sensitivity in the oesophagus
=> poor oesophageal clearence

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2
Q

what can prolonged reflux lead to

A 
oesophagi's
benign oesophageal strictures
barrett's oesophagus
haemorrhage
adenocarcinoma
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3
Q

typical s/s GORD

A 
heart burn
chest pain
water brash
dysphagia
odynophagia
acid reflux
weight loss
damage to enamel
adult onset asthma and cough
laryngitis
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4
Q

what are some risk factors of GORD

A 
alcohol
tobacco
obesity 
caffeine
hiatus hernia
age, family history
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5
Q

main investigate for GORD

A

endoscopy

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6
Q

what are some lifestyle treatments of GORD

A

lose weight / stop smoking / avoid alcohol/fatty foods/chocolate/peppermint
small regular meals

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7
Q

what are some drug treatments of GORD

A

antacids (symptomatic)

PPIs (symptomatic and healing)

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8
Q

when is surgery indicated in GORD and what does it aim to do

A

when PPIs ineffective

aims to increase resting lower oesophageal sphincter pressure

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9
Q

what is gastroparesis

A

delayed gastric emptying (not due to obstruction)

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10
Q

typical s/s of gastroparesis

A

fullness/bloating
nausea and vomiting
weight loss
upper abdo pain

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11
Q

what are some causes of gastroparesis

A

diabetes
weed
opiates
systemic diseases e.g. systemic sclerosis

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12
Q

what are the treatments of gastroparesis

A 
remove cause
liquid / low fat diet
small meals
promotability agents e.g. domperidone, metoclopramide
Gastric pacemaker
nutritional support
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13
Q

what are some causes of acute gastritis

A 
chemical insult
severe burn
NSAIDs
Heavy alcohol consumption
chemotherapy
head injury - increased ICP - increased stimulation of vagus nerve - increased acid production
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14
Q

gastritis is acidic damage to stomach mucosa due to imbalance in what

A

mucosal defence and acidic environment

—> superficial inflammatory erosion/peptic ulcer

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15
Q

s/s gastritis

A 
epigastric pain
bloating
fullness
heart burn
tenderness
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16
Q

ALARMS s/s gastritis

A 
A - anaemia
L - loss of weight
A - anorexia
R - recent onset/progressive
M - melenia/haematemesis
S - swallowing difficulty
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17
Q

what is chronic gastritis

A

chronic inflammation of the stomach mucosa

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18
Q

what are 2 causes of chronic gastritis

A

autoimmune

H. Pylori

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19
Q

what is the pathophysiology of autoimmune gastritis

A

autoimmune antibodies against parietal cells and intrinsic factor located in stomach body and fundus

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20
Q

what is autoimmune gastritis mediated by

A

T cells

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21
Q

what type of hypersensitivity is autoimmune gastritis

A

type IV hypersensitivity

22
Q

what is a common complication of autoimmune gastritis

A

pernicious anaemia - loss of intrinsic factor

23
Q

what are some s/s of pernicious anaemia

A 
lethargy/weakness
dyspnoea
sore tongue
mild jaundice
diarrhoea
24
Q

how can pernicious anaemia be treated

A

3 monthly injections of VB12

folic acid supplements

25
Q

what can autoimmune gastritis predispose to

A

gastric carcinoma

26
Q

where does H. Pylori reside

A

between epithelial cell surface and mucosal barrier

most commonly in antrum

27
Q

H. Pylori is …

A

gram negative
bacilli (comma shaped rods)
oxidase and catalase positive

28
Q

what is the effect of H. Pylori

A

increase in secretion of gastrin from G cells which increases HCl secretion —> peptic ulcers

29
Q

H. Pylori increases the risk of ….

A

ulceration
gastric adenocarcinoma
MALT lymphoma

30
Q

what is the test for H. Pylori

A

(13C) urea breath test (urease breath test)

or stool antigen test or serology

31
Q

if someone comes in with the symptoms of gastritis that is under 55 what should be tone

A

test for H. Pylori

32
Q

if someone comes in with symptoms of gastritis that is over 55 / has ALARMS s/s what should be done
or treated for H. Pylori and symptoms don’t improve

A

Upper GI endoscopy / gastroscopy

33
Q

what is the treatment for H. Pylori

A

PPI + 1g Amoxicillin BD + Clarithromycin 500mg BD

penicillin allergic –>
PPI + 400mg Metronidazole BD + clarithromycin 250mg BD

34
Q

how long should H. Pylori treatment be stopped before retest

A

2 weeks

35
Q

what are the 2 most common sites of peptic ulcers

A 
proximal duodenum (90%)
distal stomach (10%)
36
Q

epigastric pain that improves with meals, is felt usually 2-3 hours after a meal and often wakes patients at night is most likely a ….

A

duodenal ulcer

37
Q

what is the most common cause of duodenal ulcer

A

H. Pylori

38
Q

Epigastric pain that is felt shortly after meals and may radiate to back is most likely a ….

A

gastric ulcer

39
Q

what are some causes of gastric ulcers

A 
H. Pylori
NSAIDs
reflux of duodenal bile content
delayed epigastric emptying
increased acid secretion/failure of mucosal defence
40
Q

where in the stomach are gastric ulcers usually found

A

lesser curvature

41
Q

what is the treatment for peptic ulcers

A

PPI (lansoprazole)
H2RAs (ranitidine)
Antacid (Gaviscon)

42
Q

how are peptic ulcers diagnosed

A

test for H. Pylori

upper GI endoscopy - stop PPI for 2 weeks

43
Q

what are some complications of peptic ulcers

A 
bleeding --> anaemia
perforation
malignancy (rare)
gastric outflow obstruction
fibrosis --> stenosis
intractable pain
44
Q

what is seen in the microscopy of peptic ulcers

A 
clear cut edges, punched out 
layered:
floor - necrotic fibrinopurulent debris
base - inflamed granulation tissue
deepest layer - fibrotic scar tissue
45
Q

what would large and irregular edges indicate

A

cancer

46
Q

what are peptic ulcers

A

breach of GI mucosa

47
Q

what is the rome III criteria of functional dyspepsia

A

atleast one of following for 3 months with symptom onset 6 months prior to diagnosis

  • epigastric pain or burning
  • post prandial fullness
  • early satiety

+ no evidence of structural disease

48
Q

what is the most common cause of functional dyspepsia

A

IBS/GORD overlap

49
Q

what are some organic causes of dyspepsia

A

H. Pylori
NSAIDs/COX2
gastric cancer
peptic ulcers - most common

50
Q

what is the treatment/diagnosis of dyspepsia

A

in absence of RFs check for H. Pylori

if HP negative –> acid inhibition

51
Q

when should PPIs be taken

A

30 mins before a meal so they can begin function by the time meal is consumed

52
Q

A person comes to GP with epigastric tenderness/burning, a palpable mass in the epigastric region and postprandial fullness. what could it be?

A

Dyspepsia

year 1 (45 decks)

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