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A13THP @ UoN > Dyspepsia > Flashcards

Dyspepsia Flashcards

1
Q

What is Dyspepsia?

A

Indigestion

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2
Q

What is GORD?

A

Gastro-Oesophageal Reflux Disease

Leads to Oesophagitis

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3
Q

What can cause GORD?

A

Obesity
Pregnancy
Drug-induced

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4
Q

What is Peptic Ulceration?

A

Damage to lining of alimentary tract
Gastric/Duodenal
Erosion, damage, bleeding

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5
Q

What is Zollinger-Ellison syndrome?

A

Gastrin secreting tumour of D-cells (pancreas)

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6
Q

What is Gastritis?

A

Inflammation of the stomach

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7
Q

What effect can NSAIDs/oral steroids have on the alimentary tract?

A

Damage ie. ulceration

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8
Q

What are the signs/symptoms of Peptic Ulceration?

A 
Epigastric pain, precisely located
Hunger pain (relieved by eating)
Night pain (relieved by food, milk, antacids)
Warterbrash
Nausea/vomiting (esp. blood)
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9
Q

What is the most common cause of duodenal/gastric ulcers?

A

H. pylori (G-) infection
80-90% Duodenal
70% Gastric

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10
Q

What is the pathogenesis of ulcers due to H. pylori infection?

A

Infection leads to chronic inflammation leads to gastric damage leads to ulceration

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11
Q

What tests are available for H. pylori infection?

A

Urea breath test - pt given 13C urea, bacterial ureases convert it to 13CO2, exhaled
H. pylori antigens/antibodies (blood, saliva, stool)

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12
Q

What are the warning signs for serious alimentary disease?

A 
Age >45
Weight loss
Anaemia
Dysphagia
Haematemesis
Melaena
Upper abdominal masses
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13
Q

What factors increase acid secretion?

A

Histamine (H2 receptors)
Gastrin (CCK receptors)
AcH (M3 receptors, parietal cells)

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14
Q

What factors decrease acid secretion?

A

Prostaglandins (E2/I2) - also cyytoprotective (bicarbonate/mucus release)

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15
Q

What are the goals of treatment for Dyspepsia?

A

Symptomatic relief

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16
Q

What are the main methods of treatment for Dyspepsia?

A

Lifestyle changes (avoid causative drugs, foods, prop up in bed, remove belts)
Suppression of acid release
Mucosal protection

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17
Q

What is required for long term cure of Dyspepsia?

A

Suppression of acid release

Allows natural healing AND H. pylori infection

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18
Q

What is a further negative effect of H. pylori infection?

A

Development of gastric carcinomas

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19
Q

What are the most common antacids?

A

Sodium bicarbonate

Magensium/Aluminium Hydroxide

20
Q

How do antacids work?

A

Alkaline bases, react w/ acid to produce salt and water - RAISE pH

21
Q

What are alginates?

A

A type of anti-dyspepsia medication often combined with antacids

22
Q

How do alginates work?

A

Alginic acid combines w/ saliva
Forms viscous foam, floats on gastric contents
Protects oesophagus during reflux

23
Q

How do Histamine H2 antagonists work?

A

Antagonise H2 receptors

H2 receptors coupled via adenylyl cyclase - increase cAMP - activates proton pump

24
Q

Give examples of Histamine H2 antagonists

A

Cimetidine
Ranitidine
Famotidine

25
Q

Which Histamine H2 antagonist is more complicated to treat with?

A 
Cimetidine - inhibits CP450, many drug interactions
-Oral anticoagulants
-Phenytoin
-Carbamazepine
-TCAs
RANITIDINE FAVOURED
26
Q

How do Proton Pump Inhibitors work?

A

Irreversible inhibition of the proton pump

27
Q

Give examples of Proton Pump Inhibitors

A

Omeprazole
Pantoprazole
Lansoprazole

28
Q

What negative effects can treatment with PPIs have?

A

Inhibit H+ secretion >90% - leads to achlorhydria

Increased risk of Campylobacter infection

29
Q

What are prokinetic drugs?

A

Drugs that cause gastric emptying

30
Q

Give examples of prokinetic drugs

A

Domperidone - closure of oesophageal sphincter, opens lower sphincter
Metocloperamide - increases gastric motility/emptying

31
Q

What is Metocloperamide combined with?

A

Analgesics, accelerates absorption

32
Q

What is the most effective treatment for H. pylori eradication?

A

Antibiotic (2 from Metronidazole, Amoxicillin, Clarithromycin)
PPI/H2 antagonist
TRIPLE THERAPY for 1 wk
PPI alone for ulcer healing

33
Q

What is Bismuth Chelate?

A

Antacid that kills H. pylori

34
Q

How does Bismuth Chelate work?

A

Kills H. pylori
Coats ulcer
Absorbs pepsin
Increases prostaglandin production AND HCO3- secretion

35
Q

What is the treatment for Dyspepsia in the absence of H. pylori infection?

A

Staged approach

36
Q

What is stage 1 Dyspepsia treatment?

A

Antacid OR Alginate/Antacid

37
Q

What is stage 2 Dyspepsia treatment?

A

H2 antagonist

38
Q

What is stage 3 Dyspepsia treatment?

A

PPI

39
Q

How do NSAIDs/oral steroids have their ulcerogenic effect?

A

Inhibit prostaglandin production

  • NSAIDs inhibit COX
  • Steroids inhibit PLA2
40
Q

What are COX enzymes?

A

Cyclooxygenases

41
Q

What are the two isoforms of COX enzymes?

A

COX-1 - physiological form, gastric protection

COX-2 - pathological, inflammation

42
Q

What is Celecoxib?

A

COX-2 selective inhibitor, fewer GI side effects

43
Q

How can GI damage be minimized?

A

Prophylaxis w/ PPI

H2 antagonists less effective, give w/ Misoprostol

44
Q

What is Misoprostol?

A

Stable PGE1 analogue

45
Q

How does Misoprostol work?

A

Acts on prostanoid receptors, inhibits gastric H+ secretion

A13THP @ UoN (19 decks)

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