1. Upper GI Disease

Question 1

Medication used to treat upper GI disease can (3)

Answer 1

Eliminate formed acid/neutralise stomach acid
Reduce acid secretion
Improve mucosal barrier

Question 2

Which medication eliminates formed acid/neutralises stomach acid

Answer 2

Antacids

Question 3

Which medications reduced acid secretion (2)

Answer 3

Hydrogen receptor pump

Proton pump inhibitors

Question 4

How do medications improve mucosal barrier (2)

Answer 4

Eliminate helicobacter

Inhibit prostaglandin removal

Question 5

Drugs that exacerbate upper GI disease (2)

Answer 5

NSAIDs (stop PG production and prevent healing)

Steroids - damage ulcer healing process

Question 6

Mechanism of hydrogen receptor antagonists

Answer 6

Reduce acid production by preventing histamine activation of acid production

Question 7

Limitations of hydrogen receptor antagonists

Answer 7

Alternative pathways still operate (that can be inhibited by ACh and gastrin)

Question 8

Types of hydrogen receptor antagonists (2)

Answer 8

Ranitidine

Cimetidine

Question 9

Types of proton pump inhibitors (3)

Answer 9

Omeprazole
Lansoprazole
Pantoprazole

Question 10

Examples of oral diseases (3)

Answer 10

ROU
Lichen planus
OFG

Question 11

Examples of oesophageal disorders (3)

Answer 11

Dysphagia
Dysmobility disorders
GORD

Question 12

Definition of dysphagia

Answer 12

Food sticking in throat

Mechanical block/compression, may be intermittent

Question 13

Types of dysphagia (3)

Answer 13

Functional
Dysmobility
Due to external compression

Question 14

Causes of GORD (3)

Answer 14

Deective lower oesophageal sphincter
Impaired lower clearing
Impaired gastric emptying

Question 15

GORD may cause (3)

Answer 15

Ulceration
Inflammation
Metaplasia

Question 16

Signs/symptoms of GORD (4)

Answer 16

Epigastric burning - worse when lying down, bending, during pregnancy
Dysphagia - oesophagi’s, stricture, dysmobility
GI bleeding
Severe pain (mimics MI) - oesophageal muscle spasm/suspected MI

Question 17

What might Barrett’s oesophagus be caused by

Answer 17

Recurrent acid reflux into the lower part of the oesophagus

Question 18

Tissue change of Barrett’s oesophagus (2)

Answer 18

Metaplasia of oesophageal lining (metaplastic change to gastric-type mucosa)
Associated with a malignant change (adenocarcinoma)

Question 19

Definition of hiatus hernia

Answer 19

When a part of the stomach pushes above the diaphragm into the thorax

Question 20

Symptoms of hiatus hernia are similar to

Answer 20

GORD symptoms

Question 21

Hiatus hernia is more common in

Answer 21

Women

Question 22

GORD management involves (4)

Answer 22

Smoking cessation (improves sphincter)
Lose weight, avoid triggering activity
Medication
Increase GI motility and gastric emptying

Question 23

Medications involved with GORD management (2)

Answer 23

Antacids
Hydrogen blockers
Proton pump inhibitors

Question 24

Where can PUD appear

Answer 24

On any acid affected site (oesophagus, stomach, duodenum)

Question 25

Causes of PUD (3)

Answer 25

High acid secretion (duodenal) Normal acid secretion but reduced protective barrier (stomach) Drugs (NSAIDs, steroids)

Question 26

Excessive acid production can lead to (2)

Answer 26

Oesophageal ulcers | Duodenal ulcers

Question 27

Normal acid levels lead to

Answer 27

Reduced protective barrier

Question 28

PUD due to normal acid levels usually involves

Answer 28

H. pylori

Question 29

H. pylori infection causes (2)

Answer 29

Gastric ulcers | Chronic gastric wall inflammation (stomach lymphoma)

Question 30

H. pylori treatment (2)

Answer 30

Triple therapy | Involves two antibiotics and one PPI

Question 31

Antibiotics used in H. pylori treatment (2)

Answer 31

Amoxicillin (clarithromycin if allergic) | Metronidazole

Question 32

PPI used in H. pylori treatment

Answer 32

Omeprazole

Question 33

Signs and symptoms of PUD (3)

Answer 33

Often asymptomatic/none Epigastric burning pain Usually no physical signs

Question 34

Description of PUD related epigastric pain (3)

Answer 34

Worse before/just after meals Worse at night Relieved by food, alkali, vomiting

Question 35

When do PUD physical signs occur

Answer 35

When complications occur (bleeding, perforation, etc.)

Question 36

PUD investigations (4)

Answer 36

Endoscopy (oesophagus, stomach, duodenum) Radiology (barium meal/swallow) Anaemia tests (FBC, FOB) H. pylori tests (breath, antibodies, mucosa)

Question 37

Complications of PUD can be (2)

Answer 37

Local | Systemic

Question 38

Local complications of PUD include (4)

Answer 38

Perforation Haemorrhage Stricture Malignancy

Question 39

Systemic complications of PUD include

Answer 39

Anaemia

Question 40

PUD treatment (9)

Answer 40

``` Smoking cessation Eat small, regular meals Eradication therapy Ulcer healing drugs Endoscope Medical intervention Surgical intervention Gastrectomy Vagotomy ```

Question 41

When does PUD treatment involve medical intervention (2)

Answer 41

When reversible problems are present (lifestyle changes) | When H. pylori is present

Question 42

When does PUD treatment involve surgical intervention

Answer 42

When complications occur