CS 4 Peptic Ulcers

Question 1

What is dyspepsia?

Answer 1

A collective term related to all symptoms relating to the stomach and duodenum. It is essentially means ‘bad digestion.’

Question 2

Which cell types in the stomach regulate gastric acid secretion?

Answer 2

Goblet cells = secrete mucus to protect the mucosa

Parietal cells = main cell type that produces gastric acid

Chief cells = reduces pepsinogen

D cells = produces somatostatin

G cells = produces gastrin

Question 3

How does H. pylori cause stomach ulcers?

Answer 3

The H. pylori bacteria weakens the protective mucous coating of the stomach and duodenum, thus allowing acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer. Once there, the bacterium’s spiral shape helps it burrow through the lining.

Question 4

What are Enterochromaffin Cells?

Answer 4

Produce histamine which stimulate parietal cells.

Question 5

What are the treatments for peptic ulcers?

Answer 5

PPIs and antihistamines.

Question 6

What is the role of the enteric nervous system?

Answer 6

Produces ACh which promotes the release of gastric acid.

Question 7

What is the role of NSAIDs in peptic ulcers?

Answer 7

NSAIDs inhibit COX enzymes. This reduces prostaglandins. Prostaglandins inhibit acid secretion, stimulate mucus and bicarbonate secretion. Without prostaglandins, these protective functions are now stimulated and so damaging the stomach lining.

Question 8

How can H. pylori survive in the stomach?

Answer 8

It uses urease. It can convert urea into ammonia and carbon dioxide. Ammonia will neutralise the stomach acid helping the Bactria to survive in the stomach.

Question 9

What are ALARM symptoms?

Answer 9

ALARM Symptoms [mnemonic]
Anaemia (iron deficiency)
Loss of weight
Anorexia
Recent onset of progressive symptoms
Melaena / haematemesis
Swallowing difficulty
If dyspepsia and either >55yrs or ALARM Symptoms then ENDOSCOPY