Disorders of gastric acid and ulceration

Question 1

Symptoms of dyspepsia

Answer 1

upper abdominal pain, reflux, bloating, heartburn, nausea/vommiting

Question 2

Dyspepsia symptoms in pregnancy are often due to what?

Answer 2

GORD

Question 3

Non drug treatment of dyspepsia

Answer 3

• healthy eating
• weight loss
• avoiding trigger food
• small meals
• eating 3 to 4 hours before going to bed
• raising head of bed
• smoking cessation
• reducing alcohol

Question 4

Red flag dyspepsia symtoms

Answer 4

GI bleed, unexplained weight loss, >55, Dysphagia

Question 5

What drugs can cause dypepsia

Answer 5

Antimuscarinics, alpha blockers, aspirin, benzodiazepines, beta blockers, bisphosphonates, CCB, corticosteroids, nitrates, NSAIDS, theophyllne, TCA

Question 6

What should patients with dyspepsia be tested for?

Answer 6

H pylori

Question 7

First line treatment for uninvestigated dyspepsia

Answer 7

PPI for 4 weeks

Question 8

What do magnesium / aluminium containing antacids do to bowel habit?

Answer 8

Magnesium = diarrhoea 
Aluminium = constipating

Question 9

What is the issue with calcium continaing antacids?

Answer 9

can induce rebound acid secretion, hypercalcaemia, alkalosis, preciptiate milk-alkali syndrome

Question 10

What symptom does simeticone relieve?

Answer 10

Flatulence

Question 11

What is the brand name for sodium alginate + potassium bicarb?

Answer 11

Gaviscon advancew

Question 12

What is the dose of simeticone in children 1 month - 1 year with colic?

Answer 12

Dentinox: 2.5mL to be taken with/after feed; max 6 doses a day
Infacol: 0.5-1mL to be taken before feeds

Question 13

Two brand names of simeticone`

Answer 13

Infacol + dentinox

Question 14

What risk factors contribute to a patient being high risk of developing gastric ulcers?

Answer 14

• NSAIDS (high dose)
• > 65
• other drugs that inc. GI risks
• co morbidities (CVD, HTN, diabetes)
• heavy smoker
• excessive alchol
• prolonged duration of NSAIDS
• H pylori

Question 15

If a gastric ulcer develops due to NSAID use, what shiuld be done to treat it?

Answer 15

• PPI for 8 weeks

Question 16

How long after starting H pylori eradicatin treatment should a patient be reviewed?

Answer 16

6 - 8 weeks

Question 17

What type of NSAID causes the LEAST GI risk

Answer 17

COX 2 inhibitors

Question 18

Why cant bismuth subsalicylate be used in chidren <16

Answer 18

reye syndrome risk

Question 19

What is a caution with sucrafalte use?

Answer 19

Bezoar formation - caution in those on enteral feeds concomitantly + predisposing conditions e.g. delayed gastric emptying

Question 20

How long should the gap between enteral feed administration + sucralfate be?

Answer 20

1 hour

Question 21

Why should’nt H2 receptor antagonists be used for zollinger-ellison syndrome?

Answer 21

PPI are more effective

Question 22

What can H2 antagonsits mask the synptoms of?

Answer 22

gastric cancers

Question 23

Cimetidine can be sold OTC to patients above what age?

Answer 23

16 (provided not more than 2 week supply if sold)

Question 24

Dose of cimetidine (single dose) for nocturnal heartburn

Answer 24

100mg

Question 25

Oral preparations of Ranitidine are not licensed for children under what age?

Answer 25

3

Question 26

When rantidine is sold OTC what is the max single dose that can be given?

Answer 26

75mg (max total daily dose of 300mg)

Question 27

Example of a synthetic prostaglanding analgoue that has antisecretory properties used to help heal gastric ulcers

Answer 27

misoprostol

Question 28

what drug class can be used for endoscopic treatment of severe peptic ulcer bleeding?

Answer 28

PPI (IV)

Question 29

What condition can PPIs be used for the reduce degradtion of pancreatic enzyme supplements?

Answer 29

Cystic fibrosis

Question 30

What is the MHRA warning alert associated with PPIs

Answer 30

small risk of SLE

Question 31

What are some cautions of PPI use?

Answer 31

1) mask symptoms Gastric cancers 2) risk of osteoporosis 3) Risk of c.diffe

Question 32

Is hypomagnesmia common immediately after starting PPIS?

Answer 32

no - usually occurs after 1 year of treatment

Question 33

What electrolyte should be monitored when using PPI therapy

Answer 33

magensium ( + sodium(

Question 34

What strength of omeprazole can be sold OTC to adults > 18years

Answer 34

10mg caps

Question 35

Pantoprazole 20mg capsules can be sold OTC to what age group

Answer 35

> 18

Question 36

complications of GORD

Answer 36

ulceration, oesophageal strictures, haemorrhage, aneamia due to chronic blood loss, aspiration pneumonia, barretts oesophageous

Question 37

Sodium alginate wiht calcium carbonate and sodium bicaroate brand names

Answer 37

Peptac, Gaviscon, Rennie

Question 38

What patients should be tested for H pylori

Answer 38

1) pt with uncomplicated dyspepsia and no alarm sx who are unresponsive to lifestyle change + 1/2 months of PPI 2) Pt at high risk (older, North African) 3) History of peptic bleed/ulcers 4) Prior to initiating NSAIDS in pt with history of ulcer 5) Pt with unexplained iron deficiency anaemia

Question 39

What tests can be used for h pylori

Answer 39

Urea C13 breath test, stool H pylori antigen (SAT) or laboratory based serology

Question 40

PHE recomends that C13 breath test / SAT should not be performed in what circumstance?

Answer 40

within 2 weeks of treatment wiht PPI or 4 weeks of an antibiotic (leads to false negatives)

Question 41

What drug classes are used for H pylori eradication

Answer 41

1 PPI + 2 antibiotics

Question 42

First line oral therapy for treatment of h pylori

Answer 42

PPI + amoxicillin and either clarithromycin or metronidazole for 7 days

Question 43

If a patient with h pylori has recently had both clarithromycin and metronidazole, what other antibiotic can be tried?

Answer 43

tetracycline

Question 44

If a patient has a penicillin allergy, what regime should be given for H pylori eradication

Answer 44

PPI + metro + clari for 7 days