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GI - Year 2 > H. Pylori and Gastric Disease > Flashcards

H. Pylori and Gastric Disease Flashcards

1
Q

What is dyspepsia?

A

Indigestion

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2
Q

What are the symptoms of dyspepsia?

A 
Pain/discomfort in upper abdomen
Retrosternal pain
Anorexia
Nausea
Vomiting
Bloating
Fullness
Early satiety
Heartburn
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3
Q

What can cause the symptoms of dyspepsia?

A 
Upper GI (GORD, peptic ulcer, gastritis, non-ulcer dyspepsia, gastric cancer)
Hepatic causes gallstones
Pancreatic disease
Lower GI (IBS, Colonic cancer)
Coeliac disease
Psychological
Drugs
Other systemic diseases - metabolic, cardiac
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4
Q

What blood investigations are done in patients with dyspepsia?

A 
FBC
Ferritin
LFTs
U&Es
Calcium
Glucose
Coeliac serology/serum IgA
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5
Q

What medications do you check in patients with dyspepsia?

A 
NSAIDS
Steroids
Bisphosphonates
Ca antagonists
Nitrates
Theophyllines
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6
Q

What are symptoms that suggest endoscopy is required?

A

Anorexia
Loss of weight
Anaemia - iron deficiency
Recent onset > 55 years or persistent despite treatment
Melaena/haematemesis (GI bleeding) or mass
Swallowing problems - dysphagia

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7
Q

What is helicobacter pylori?

A

Gram negative bacteria
Spiral-shaped
Microaerophilic
Flagellated

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8
Q

Where does H.pylori infection occur?

A

In the surface mucous layer and does not penetrate the epithelial layer
Can ONLY colonise gastric type mucosa

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9
Q

What are the clinical outcomes of helicobacter pylori infections?

A 
Asymptomatic or chronic gastritis (>80%)
Chronic atrophic gastritis
Intestinal metaplasia
Gastric or duodenal ulcer (15-20%)
Gastric cancer
MALT lymphoma <1%
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10
Q

What is the outcome of helicobacter pylori dependent on?

A

Site of colonisation
Characteristics of bacteria
Host factors e.g. genetic susceptibility and other environmental factors

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11
Q

What are the non-invasive diagnostic tests for H.pylori infection?

A

Serology- IgG against H. pylori
13c/14c urea breath test
Stool antigen test - ELISA - need to be off PPI for 2 weeks

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12
Q

What are the invasive diagnostic tests

A

Endoscopy
Histology - gastric biopsies stained for the bacteria
Culture of gastric biopsies
Rapid slide urease test (CLO)

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13
Q

What does an IgG positive test for H.pylori infection mean?

A

Patient could have been previously exposed and still has antibodies for it
Not necessarily an active infection

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14
Q

What type of gastritis is caused by H. pylori?

A

Bacterial

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15
Q

What are peptic ulcers caused by?

A

Majority caused by H. pylori

Can be caused by other conditions such as Zollinger-Ellison syndrome, hyperparathyroidism, Crohn’s disease

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16
Q

What symptoms are associated with peptic ulcers?

A 
Epigastric pain
Nocturnal/hunger pain 
Back pain
Nausea and occasional vomiting
Weight loss/anorexia
If ulcer bleeds, potential haematemesis and/or melaena, or anaemia
17
Q

How are peptic ulcers treated?

A

Ulcers caused by H. pylori treated by eradication therapy
Antacid meds - proton pump inhibitors or H2 receptor antagonists
If NSAIDS involved, must be stopped
Surgery only in complicated PUD

18
Q

How is eradication of H. pylori infection done?

A 
Triple therapy for 7 days of:
- clarithromycin
- amoxycillin
- PPI
May differ dependent on local antibiotic resistance profiles
19
Q

What are the main reasons for eradication of H. pylori not to work?

A

Resistance to antibiotics

Poor compliance

20
Q

What are the complications of a peptic ulcer?

A

Acute bleeding - melaena and haematemesis
Chronic bleeding - iron deficiency anaemia
Perforation
Fibrotic stricture (narrowing)
Gastric outlet obstruction - oedema or stricture

21
Q

What are the clinical signs of gastric outlet obstruction?

A

Vomiting - lacks bile, fermented foodstuffs
Early satiety, abdominal distension, weight loss, gastric splash
Dehydration and loss of H+ and Cl- in vomit
Metabolic alkalosis
Bloods - low Cl, low Na, low K, renal impairment

22
Q

How is gastric outlet obstruction diagnosed?

A

Upper GI endoscopy (prolonged fast/aspiration of gastric contents) to identify cause (stricture, ulcer, cancer)

23
Q

How is gastric outlet obstruction treated?

A

Endoscopic balloon dilatation

Surgery

24
Q

What are the signs of gastric cancer?

A 
Dyspepsia
Early satiety
Nausea + vomiting
Weight loss
GI bleeding
Iron deficiency anaemia
Gastric outlet obstruction
25
Q

What are the staging investigations for gastric cancer?

A

CT chest/abdomen

MDT discussion - imaging/histology/patient fitness

26
Q

What is the treatment for gastric cancer?

A

Surgery

Chemotherapy/radiotherapy

GI - Year 2 (39 decks)

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