Flashcards in Gastro-duodenal disorders Deck (36):
1
Define peptic ulcer disease (PUD)
Gastric and duodenal ulcers
2
What is the commonest cause of peptic ulcer disease?
H. pylori infection (95% of duodenal, 80% of gastric)
3
What type of bacteria is H. pylori?
Gram -ve aerophillic helicobacter
4
How can H. pylori infection be detected?
Urease breath test
Histology
5
Describe the pathogenesis of H. pylori induced peptic ulcer disease
H. pylori converts urea to ammonia ➔ neutralises stomach pH and is toxic to epithelium
6
Outline the treatment for H. pylori
Triple therapy BD for 7 days
-Omeprazole or lansoprazole
-Clarithromycin 500mg
-Amoxicillin 1g
or
-Omeprazole or lansoprazole
-Clarithromycin 250mg
-Metronidazole 400mg
7
How can peptic ulcers be classified?
Gastric ulcers (Type I, body and fundal)
Duodenal ulcers
Gastric ulcers (Type II, prepyloric)
Atypical ulceration
8
Who tends to get gastric ulcers, and where are they most commonly located?
Elderly (M>F 3:1)
Lesser curve of the stomach
9
Name 3 risk factors for gastric ulceration
H. pylori (80%)
High alcohol intake
Smoking
NSAIDs
Reflux of duodenal contents
Normal or low acid secretion
Delayed gastric emptying
Stress
10
Describe the symptoms of gastric (type I) ulceration
Asymptomatic
Epigastric pain (burning shortly after meals)
Weight loss
Anorexia
11
Describe the epidemiology of duodenal and gastric (type II) ulceration
M>F 5:1
Peak age 25-30yrs
12
Name 3 risk factors for duodenal ulceration
H. pylori (90%)
NSAIDs, steroids, SSRIs
High acid secretion
Increased gastric emptying
Smoking
13
Describe the symptoms of duodenal ulceration
Asymptomatic (50%)
Epigastric pain (before meals or at night)
-Relieved by eating
14
Name 2 types of atypical peptic ulceration
Ectopic gastric mucosa in Meckel's diverticulum
Zollinger-Ellison syndrome: non-beta islet cell gastrinoma of the pancreas
15
Differentiate between gastric and duodenal ulcerations
Gastric: Pain precipitated by food, weight loss, anorexia
Duodenal: Central back pain relieved by food, often occurs at night and early hours of morning
16
How is peptic ulcer disease investigated?
Gastroscopy*
Barium meal
Urease breath test - detect H. pylori
Fasting serum gastrin levels - suspected hypergastrinaemia e.g. ZES
Hypercalcaemia
17
Name 3 complications of peptic ulcer disease
Acute upper GI bleeding
Iron deficiency anaemia
Perforation
Gastric outlet obstruction
18
Outline the management of peptic ulcer disease
Lifestyle: Alcohol and smoking cessation, avoid trigger foods, stress management
Medical: Avoid NSAIDs and aspirin, H. pylori eradication if needed, low-dose PPI or standard-dose H2RA, antacids
Surgical: Pyloroplasty +- selective vagotomy, partial gastrectomy
19
What are the surgical indications for peptic ulcer disease?
Failure to respond to maximal medical treatment
Complications: bleeding, perforation, pyloric stenosis
Gastric outflow obstruction not responsive/suitable for balloon dilatation
20
Name 3 causes of acute upper GI perforation
Duodenal ulceration
Gastric ulceration (usually anterior prepyloric)
Gastric carcinoma
Traumatic injury
Ischaemia (usually secondary to gastric volvulus)
21
Name 3 symptoms seen in acute upper GI perforation
Acute onset upper abdominal pain
-Severe constant pain that worsens with breathing and movement, may radiate to back or shoulders
Prodrome of upper abdominal pain ➔ ulceration
Copious vomiting and distension ➔ volvulus
Prodromal weight loss, dyspepsia, anorexia ➔ carcinoma
22
Name 3 signs seen in acute upper GI perforation
Generalised peritonism: washboard rigidity, guarding, tenderness, Rovsing's sign
Localised peritonism
Distension
Systemic: mild fever, pallor, tachycardia, hypotension
23
How can GI perforation be confirmed?
Erect CXR for pneumoperitoneum
CT scan
24
Outline the definitive management of upper GI perforation
Duodenal ulcer ➔ Omental patch + H. pylori eradication, partial gastrectomy +- vagotomy if recurrent
Gastric ulcer ➔ Omental patch if prepyloric (type II), local excision and sutured closure if body (type I)
Gastric carcinoma ➔ Partial gastrectomy
Traumatic ➔ Sutured closure
Ischaemic volvulus ➔ Subtotal gastrectomy
25
When is conservative management of upper GI perforation appropriate?
Patient declines surgery
Patient unlikely to survive surgery
Haemodynamically stable with small perforation (sealed at presentation) and no signs of peritonism
26
Outline conservative management of upper GI perforation
IV PPI
Limited oral intake
Active physiotherapy
H. pylori eradication
27
Describe the epidemiology of gastric cancer
5th commonest cancer in the world
3rd leading cause of cancer death worldwide
28
Name 3 types of gastric cancer
Adenocarcinoma*
Leiomyosarcoma
GI stromal tumour
Carcinoid tumour
Lymphoma
29
Describe the epidemiology of gastric adenocarcinoma
Commonest age >50s (95% occur in over 55s)
M>F 3:1
30
List 35risk factors for gastric cancer
Increasing age esp >45
Male
H. pylori
Diet: rich in nitrosamines, low in fruit and veg
Smoking
Chronic atrophic gastritis
Family history
Blood group A (RR 1.2)
31
Name 4 symptoms of gastric cancer
Dyspepsia
Weight loss, anorexia, and lethargy
Abdominal pain
Iron deficiency anaemia
Upper GI bleeding
Dysphagia (uncommon unless involving gastro-oesophageal junction)
32
Name 2 signs of gastric cancer
Weight loss
Palpable epigastric mass
Troisier's sign (palpable left supraclavicular LN) ➔ metastases
33
How is gastric cancer investigated?
FBC and LFTs
Endoscopy
Barium swallow
34
Where does gastric cancer commonly metastasise?
Lungs
Liver
Lymph nodes
Oesophagus
(Krukenberg tumour of the ovaries)
Indicted by Troisier's sign
35
What is the prognosis of gastric cancer in the UK?
Majority of gastric cancers are metastatic or unresectable upon presentation.
36