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home - Stomach - Peptic Ulcer Disease - Helicobacter Pylori structure Written by Dr Sebastian Zeki
Knowledge

Knows the range of organic and non-organic causes of dyspepsia. Be
aware of current BSG and NICE guidelines for selecting patients for
investigation. Know the significance of alarm symptoms
Understands the relevance of Helicobacter pylori infection and how it
can be detected and treated.
Recognise the adverse effect of nonsteroidal anti-inflammatory drugs
Understands the physiology of gastric acid secretion, mucosal
protection and gastroduodenal motility and know how drugs can
modify these
Knows the complications of ulcer disease, the principles of surgery
that may be required and be aware of post-operative sequelae

Skills
Makes a thorough clinical assessment, perform appropriate
investigations and be familiar with how medical treatments are used.
Show awareness of how to recognise and manage complications

Behaviours
Can explain the steps taken towards making a diagnosis and
planning treatment clearly and comprehensibly

Also....

Knowledge
Knows the causes of upper gastrointestinal bleeding and its
presentation
Understands the circulatory disturbance associated with blood loss
and the pathophysiology underlying the clinical manifestations of
hypovolaemic shock
Knows the principles of assessing hypovolaemia and of restoring the
circulation. Be able to identify and correct coagulopathy
Knows the principles of using the various risk stratification tools SCE 1
Knows how endoscopic techniques are used to control bleeding CbD, DOPS, SCE 1
Understands how oesophageal and gastric varices develop and the
endoscopic and pharmacological methods that are used to control
blood loss

Skills
Can make an accurate clinical assessment, and stratify the risk. Know
the principles of fluid resuscitation and arrange endoscopy
Is aware of methods to secure haemostasis, recognise signs of rebleeding and liaise with other disciplines (such as interventional
radiology or surgery

Behaviours
Assesses and treats patients who have bleeding with appropriate
degree of urgency.

Also...
Knowledge


Understands why part or all of the patient’s stomach is removed and
the altered post-surgical anatomy

Understands the problems of a gastro-enterostomy and a Roux-en-y
anastomosis

Has awareness of dumping syndromes
Knows the various surgical operations performed for obesity (bariatric
surgery) and their complications

Skills
Can give nutritional advice and choose the appropriate method by
which an enteral feeding tube is inserted into the small bowel

Can initiate the use of pancreatic enzyme therapy
Has ability to recognise and treat early and late dumping syndrome
Behaviours
Able to help the patient carers friends and family understand how
the patient can be encouraged to gain weight

Works closely with dieticians and surgical colleagues

Helicobacter Pylori structure

Secreted proteinsVacACagAOther Proteins LPS Nitrogen metabolism enzymesUreaseArgnase Adherence Factors Flagellae 0.5 microns 3.5 microns Staining Methods:H&E- is not used as it is difficult.The quick Giemsa method-is preferred.Immunostaining techniques- highly sensitive and reliable.Silver stains- not used. Coccoid form More resistant so survives in faeces or in drinking water.May need immunostaining to determine if H. pylori in coccoid form Coccoid form if not ideal growing conditions/ undergoing treatment Culturing H. PyloriCulture in blood agar/ Skirrows media.Incubate at 37ºC in a 5 % O2 for 3-7d. Characteristics:It is spiral shaped.It is microaerophilic.It is gram negative.It is slow growing. EpidemiologyIt is present in 50% of the world's population.Infection is more frequent and acquired at an earlier age in developing countries compared to industrialized nations.In developing nations children are infected before the age of 10 and adults infection > 80 % before age 50.In developed countries rare before the age of 10, 10% in those between 18 -30 yrs and 50% if > 60yrs. Helicobacter Pylori ReinfectionRecurrence is usually recrudescence.Reacquisition occur in <2%/ year. Possible hereditary susceptibility — Hispanics and African-Americans have a higher rate of infection than Caucasians.- not explained by being poor.For H. pylori infection: MZ twins raised apart > DZ twins raised apart. TransmissionIt can occur among family members during periods of illness via diarrhoea and vomitus.Bacteria can survive in water for several days. Written by Dr Sebastian Zeki

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