Dyspepsia and GORD Flashcards
What is dyspepsia?
indigestion
pain in upper abdomen
what is GORD?
Gastroesophageal reflux disease
exposure of unprotected epithelium to stomach acid
what is a peptic ulcer?
A perforation or hole in the lining of the small intestine, lower oesophagus or stomach
what is acid secretion like in gastric ulceration?
normal or decreased
where is the damage in gastric ulceration?
whole gastric area
what is acid secretion like in duodenal ulceration?
increased secretion
where is the damage in duodenal ulceration?
inflammation elevated in pyloric region
what are risk factors to dyspepsia and GORD?
caffeine, smoking, alcohol, stress
what is non-erosive GORD?
heartburn
what is erosive oesophagitis?
acute inflammatory response
what is LOS relaxation?
relaxation of lower oesophageal sphincter in absence of swallowing
what receptor does transient LOS relaxation stimulate?
gastric vagal mechanoreceptors
what drugs are contraindicated in dyspepsia and GORD?
NSAIDs and aspirin
why do NSAIDs affect the stomach?
COX inhibitors reducing prostaglandins which protect stomach lining
what is used to prevent damage due to long term NSAID use?
stable prostaglandin E1 (PGE1)
what effect does aspirin have on the stomach?
irreversible inhibition of stomach protection
direct toxicity
3 strategies of treatment?
- neutralisation
- reduction of acid secretion
- prokinetics
what drug classes come under neutralisation?
Antacids, alginates and sucralfate
what drugs reduce acid secretion?
PPIs and H2 receptor antagonists
type of prokinetics drug?
dopamine receptor antagonists
what are antacids and how do antacids work?
weak bases that neutralise acid
buffer acid to increase pH
what do antacids NOT do?
don’t prevent over production of acid
how do alginates work?
form protective barrier on top of gastric contents - gel impedes reflux
what does sucralfate do?
protects - treatment of ulceration
how do PPIs work?
bind to cysteines of H+/K+ ATPase (proton pump) - prevents H+ movement into stomach, preventing acid formation/secretion of acid
what is the name when all gastric acid secretion is blocked?
achlorhydria
how do dopamine receptor antagonists work?
enhance gastric motility to increase emptying
why are dopamine receptor antagonists barely used?
severe side effects
