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Chapter 1 - Gastrointestinal system > 6. Gastric acid disorders and ulceration > Flashcards

6. Gastric acid disorders and ulceration Flashcards

1
Q

Dyspepsia symptoms

A
  • Upper abdominal pain
  • Heartburn
  • Gastric reflux
  • Belching/gas
  • Bloating/feeling full
  • Nausea/vomiting
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2
Q

Dyspepsia Red flag symptoms

A
  • Gastro-intestinal bleeding (may caused by peptic ulcer)

The below symptoms may be a sign of oesophageal or stomach cancer:
* Unexplained weight loss
* Dysphagia
* 55+ years and with dyspepsia

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3
Q

Causes of dyspepsia

A
  • Peptic ulcers
  • GORD
  • Cancer
  • Drugs: NSAIDs, Nitrates, Bisphosphonates, CCB’s, corticosteroids (side effect)
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4
Q

Uninvestigated Dyspepsia treatment

A
  • PPI for 4 weeks
  • H.pylori test. If the test comes out positive eradication therapy should follow

‘High-risk’ patients (e.g elderly, north africans and certain areas) must be tested first OR in parallel with a PPI course

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5
Q

Functional dyspepsia treatment

A
  • PPI or H2 receptor antagonist for 4 weeks
    AND
  • test for H.pylori, if symptoms come out positive eradication therapy should follow

If symptoms come back, use treatment on an as needed basis

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6
Q

Gastro-oesophageal reflux disease

A

When gastric content is regurgitated back into the oesophagus. As the oseophagus sphincter becomes weaker

Has two types: erosive and non-erosive

Erosive: where oesophageus is inflammed

Non-erosive

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7
Q

GORD causes

A

NSAIDs, Nitrates, Bisophosphonates, Calcium-channel blocker, corticosteroid, alpha-blocker, antimuscarinic, beta-blocker, TCA

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8
Q

GORD symptoms

A
  • Heartburn
  • Unpleasant sour taste in the mouth
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9
Q

GORD treatment

A
  • Uninvestigated GORD: 4 weeks with a PPI
  • Diagnosed GORD with endoscopy: PPI 4 or 8 weeks
    If there is no response, a H2 receptor antagonist can offered.
    The lowest effective dose can be taken on an as needed basis
  • Severe oesophagitis: PPI for 8 weeks. If this fails, try an higher dose or switch to another PPI
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10
Q

GORD treatment in pregnancy

A

1st line: Diet and lifestyle advice

2nd line: Antacid

For severe symptoms
3rd line: Omeprazole

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11
Q

P

Peptic ulcers

A

An open sore in the mucosal lining of the stomach or the duodenum

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12
Q

Causes of peptic ulcer

A
  • NSAIDs
  • h. pylori
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13
Q

Patients at risk of peptic ulcer

A

History of complicated ulcer
or have at least 2 of the following risk factors:
* 65+ years
* High dose and prolonged use
* Drugs which increase the risk of GI bleeding, e.g SSRI’s
* Serious co-morbidity e.g CVD, HT, diabetes
* Excessive alcohol
* NSAID adverse reaction

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14
Q

Peptic ulcer symptoms

A
  • Burning abdominal oain
  • Dyspepsia
  • Heartburn
  • Nausea
  • Bloating
  • Apetite loss
  • Weight loss
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15
Q

Types of peptic ulcer

A
  • Gastric ulcers
  • Duodenal ulcers
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16
Q

NSAID-induced ulcer treatment

A
  • PPI or H2 receptor antagonist for 8 weeks
  • Conduct a H.pylori test, if positive, start eradication therapy.
  • Stop NSAID, (can swicth to paracetamol, may not be possible in chronic conditions e.g rheumatoid arthritis).
    Can switch to COX-2 selective inhibitor (as they cause less GI side effects but have a higher risk of cardiovascular events) + Gastro-protection (like PPI, H2 receptor antagonist, misoprostol)

consider other co-morbidities the patient will have

17
Q

Peptic ulcers treatment (not caused by NSAID or h.pylori)

A

PPI or h2 receptor antagonist 4 to 8 weeks

18
Q

Diagnosing h.pylori infection

A

Urea breath test and Stool antigen test

The test should not be performed within 2 weeks of a PPI OR 4 weeks of an antibiotic as this may causen a false negative

19
Q

H.pylori eradication therapy

A

Treatment lasts for 7 days:

1st line: PPI + amoxicillin + clarithromycin OR metronidazole
PAC/PAM

if penicillin allergy: PPI + metronidazole + clarithromycin
PMC

2nd line: if PAC was used first line use PAM and vice versa

if penicillin allergy: PPI + metronidazole + levofloxacin
PML

If patient has recently used an antibiotic for an unrelated infection, it cannot be given again to reduce the risk of resistance

20
Q

Antacid mechansims of action

A

Neutralises gastric acid. Provides relief within 15-30 minutes

21
Q

Alginates mechanism of action

A

Forms a viscous gel raft ontop of the stomach contents. This prevents it from being regurgitated

22
Q

Types of antacids and alginates

A

Antacids
Magnesium salt - laxative effects
Aluminium salt - constipative effects

Alginates
* alginic acid
* sodium alginate

Gaviscon contains both antacid and alginates

Liquid formulations are more effective than tablets

23
Q

Antacids/alginates caution

A

Many preparations of antacids and alginates are high in Na+ content, take caution in:

  • Hypertension (increases fluid retention)
  • Heart, Liver, Kidney failure (increases fluid retention)
  • Lithium (as sodium-restricted diet must be followed)
24
Q

Antacids counselling

A

Should be taken after each meal, at bedtime or prn

25
Q

Antacids interactions

A

Drug interactions
Antacids reduce the absorption of:
tetracyclines, bisphosphonates, quinolones (ciprofloxacin).
Therefore leave 2 hours before or after taking the antacid

Enteric coatings
Enteric coatings are designed to break down in alkaline conditions.
Antacids damage enteric coatings as they neutralise the stomach acid therefore the coatings dissolve prematurely

26
Q

PPI mechanism of action

A

Block the H+/K+/ATPase in parietal cells, therefore blocking acid secretion

27
Q

Examples of PPI’s

A

Lansoprazole (taken 30-60 minutes before food)
Esomeprazole
Pantoprazole

28
Q

PPI’s and pregnancy

A

Omeprazole is safe in pregnancy

29
Q

PPI counselling

A
  • Should be swallowed whole, not chewed or crushed
  • Take it at the lowest effective dose for shortest period
  • Leave a 2 hour gap, before taking any indigestion remedy (as PPI’s are enteric coated). It is recommended to take it first thing in the morning, 30-60 minutes before food
30
Q

PPI side effects

A
  • GI disturbances - abdominal pain, diarrhoea, nausea
  • Subacute cutaneous lupus - rash on sun exposed areas, can occur weeks to years after treatment
  • Long term - increased of fractures
  • Long term - hyPOmagnesia
    Must monitor magnesium levels especially in patients taking digoxin as hyPOmagnesia can predispose to digoxin toxicity
31
Q

PPI cautions

A
  • Can mask symptoms of stomach cancer
  • Can increase the risk of factures, therefore preventative treatment may be required especially in the elderly
  • Can increase the risk of GI infections such as C.dificile as PPI’s reduce stomach acidity can encourage microbial growth
32
Q

PPI interactions

A

Omeprazole is a cytochrome P450 enzyme inhibitor…

  • Omeprazole and Esomeprazole should not be used by patients taking clopidogrel as there is a reduced antiplatelet effect
  • Omeprazole and Esomeprazole reduce the clearance of methotrextae = methotrextae toxicity
33
Q

H2 receptor antagonists mechanism of action

A

Blocks gastric acid secretion by inhibiting H2 receptors in parietal cells

34
Q

H2 receptor antagonists

A
  • Cimetidine (rarely used as it is an enzyme inhibitor and reacts with too many drugs)
  • Famotidine
  • Nizatidine
35
Q

H2 receptor antagonist side effect

A
  • Headaches
  • Rashes
  • Dizziness
  • Diarrhoea
36
Q

H2 receptor antagonist caution

A

Masks symtoms of gastric cancer like PPI’s

Chapter 1 - Gastrointestinal system (14 decks)

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