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Body Systems > Dyspepsia and peptic ulcer > Flashcards

Dyspepsia and peptic ulcer Flashcards

1
Q

what is dyspepsia

A

bad digestion

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2
Q

describe the rough organisation of a gastric pit cell from top to bottom

A 
goblet cells 
parietal cells 
chief cells 
D cells 
G cells
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3
Q

what do the cells of the gastric pit secrete

A

goblet - mucus - protect stomach lining
parietal cells - gastric acid - HCL
chief cells - pepsinogen - protease precursor
D cells - somatostatin - inhibits acid secretion
G cells - gastrin - stimulates acid secretion

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4
Q

how is HCL secreted from parietal cells

A

on basal side near interstitial fluid and capillary there is a Cl- HCO3 anti-transporter (Cl in and bicarbonate out)
the cl then moves passively down its con gradient out of the apical surface into the lumen
h20 in the cell splits and binds with co2 to get bicarbonate which leaves the basal side but the H+ from water uses active transport to pump H+ into the lumen and K+ back into the cell
K then freely leaks back into the lumen to repeat

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5
Q

describe the pathway of stimulation of parietal cells to release HCL

A

G cells release gastrin which stimulate ECL cells to release histamine. histamine stimulates parietal cells to release HCL
enteric neurons also release ACh which stimulates parietal cells

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6
Q

describe the negative feedback of HCL release from parietal cells

A

HCL stimulates somatostation releasing cells to release somatostatin
they directly inhibit parietal cells
inhibit ECL cells and inhibit G cells

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7
Q

what do PPI’s do

A

proton pump inhibitors stop HCL release from parietal cells

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8
Q

what do H2 blockers do

A

stop ECL cells from releasing histamine

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9
Q

what are the signs and symptoms of a peptic ulcer

A 
epigastric pain - after eating, may be relieved by antacids, eating or drinking milk 
epigastric tenderness 
nausea 
anorexia 
weight loss
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10
Q

what are the four definitions of dyspepsia

A

D with alarm symptoms - red flag features
uncomplicated D - without red flag features
uninvestiagated D - D presenting to a clinician for the first time
functional D (non-ulcer) - D but no structural cause for symptoms at upper GI endoscopy

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11
Q

what are alarming features of dyspepsia

A 
weight loss 
dysphagia 
persistent vomiting 
haematemesis or melaena (dark sticky faeces - internal bleeding) 
palpable gastric mass 
family history or gastric cancer 
D onset over 45-55 years
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12
Q

what are the potential causes of dyspepsia

A

gastro-oesophageal reflux disease - 13%
peptic ulcer - 8%
gastric cancer less than 1%
functional dyspepsia - 80% due to normal endoscopy

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13
Q

which countries most commonly have dyspepsia

A

russia, UK, south american countries

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14
Q

how much does dyspepsia cost the Uk per year

A

£500 mil

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15
Q

how common is dyspepsia

A

prevalence of 20-40%

incidence of around 2% per year

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16
Q

what is the prognosis variability of dyspepsia

A

40% long term symptoms

60% experience resolution of symptoms

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17
Q

when would you do an endoscopy for dyspepsia

A

if there are any signs of alarm symptoms

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18
Q

what are the approaches to uncomplicated/simple dyspepsia

A

endoscopy, test for H pylori, empirical PPi

19
Q

how do you know which treatment to use for uncomplicated dyspepsia

A

endoscopy is best for effect of symptoms but not cost effective

20
Q

what are the common causes of peptic ulcer

A

H pylori 5% of cases non-steroidal and aspirin

21
Q

what are the more rare causes of peptic ulcer

A

zollinger-ellison syndrome

crohns disease

22
Q

what is the relationship between helicobactor and peptic ulcer

A

casually implicated in the disease

60% gastric and 80% duodenal ulcer as well strong association with gastric cancer

23
Q

how was helicobactor eradicated

A

PPI’s and 2 antibiotics

24
Q

how does H pylori fester in the stomach

A

bacterium produces urease which turns urea into ammonia and water which neutralises stomach acid for survival

25
Q

what are the non invasive and invasive measures for diagnosing H pylori

A 
non: carbon urea breath test 
H pylori serology 
Hy pylori stool antigen 
invasive 
rapid urease test 
biopsy
26
Q

what do you treat H pylori with

A

PPI with two antibiotics such as amoxicillin, calithromycin or metronidazole

27
Q

what are three complications of peptic ulcer

A

perforation
bleeding
gastric outlet obstruction - pylori stenosis

28
Q

how do you treat peroration or pyloric stenosis

A

surgery

29
Q

how do you treat bleeding from peptic ulcer

A

endoscopy

30
Q

what are the symptoms and signs of peptic ulcer bleeding

A 
haematemesis 
coffee ground vomiting 
melaena 
rectal bleeding 
tacky cardia 
hypotension
31
Q

some strains of H pylori express which toxins and what do they do

A

Cage and VacA which produce higher levels of inflammation

32
Q

which blood group is more susceptible to peptic ulceration

A

blood group O has increased risk of duodenal ulceration

33
Q

what is the biochemical name for the proton pump

A

H+/K+ ATPase

34
Q

how does aspirin cause excess gastric acid release

A

COX makes prostoglandins from arachidonic acid. PGE2 modulates gastric secretion via Gi which inhibits adenylate cyclase. inhibition of COX via aspirin reduces prostolglandins which in turn leads to a rise in acid secretion

35
Q

which COX is responsible for inflammation

A

COX2

36
Q

which COX is responsible for effects on gastric mucosa

A

COX1

37
Q

why is celecoxib preferred in long use over ibuprofen

A

celexoib is more specific to COX 2 and therefore less likely to produce ulceration

38
Q

why does aspirin cause haemorrhages from peptic ulcer

A

inhibits cox and inhibits thromboxane A2 and stops platelet aggregation - antiplatelet

39
Q

what does H2 antagonists do for anti-ulcer drugs

A

ranitidine (zantac)
famotidine (pepcid)
binds to H2 receptor preventing binding of histamine and decreasing acid release

40
Q

how do PPI’s aid as anti-ulcer drugs

A

lansoprazole
omeprazole
pantoprazole
direct inhibition of K+/H+ ATPase which pumps H+ ions into the stomach

41
Q

what is melaena and what is it a sign of and what is it associated with

A

dark stool - blood in stool - could be due to peptic ulcer

can cause anaemia and therefore shortness of breath

42
Q

what physiological observations would you make for someone with suspected haemorrhage peptic ulcer

A

pulse - tachycardia
blood pressure - hypotension
indicative of blood loss

43
Q

what abnormalities would you see on a blood test with peptic ulcer bleeding

A

below normal levels of blood (normal 13-17 g Hb/dl in men, 11-15 in women)
test for urea - would be raised

44
Q

what additional test would you do if someone had haemorrhage peptic ulcer

A

biopsy and urease test for H pylori

Body Systems (77 decks)

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