Dyspepsia and peptic ulcer Flashcards
what is dyspepsia
bad digestion
describe the rough organisation of a gastric pit cell from top to bottom
goblet cells parietal cells chief cells D cells G cells
what do the cells of the gastric pit secrete
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
how is HCL secreted from parietal cells
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
describe the pathway of stimulation of parietal cells to release HCL
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
describe the negative feedback of HCL release from parietal cells
HCL stimulates somatostation releasing cells to release somatostatin
they directly inhibit parietal cells
inhibit ECL cells and inhibit G cells
what do PPI’s do
proton pump inhibitors stop HCL release from parietal cells
what do H2 blockers do
stop ECL cells from releasing histamine
what are the signs and symptoms of a peptic ulcer
epigastric pain - after eating, may be relieved by antacids, eating or drinking milk epigastric tenderness nausea anorexia weight loss
what are the four definitions of dyspepsia
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
what are alarming features of dyspepsia
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
what are the potential causes of dyspepsia
gastro-oesophageal reflux disease - 13%
peptic ulcer - 8%
gastric cancer less than 1%
functional dyspepsia - 80% due to normal endoscopy
which countries most commonly have dyspepsia
russia, UK, south american countries
how much does dyspepsia cost the Uk per year
£500 mil
how common is dyspepsia
prevalence of 20-40%
incidence of around 2% per year
what is the prognosis variability of dyspepsia
40% long term symptoms
60% experience resolution of symptoms
when would you do an endoscopy for dyspepsia
if there are any signs of alarm symptoms
what are the approaches to uncomplicated/simple dyspepsia
endoscopy, test for H pylori, empirical PPi
how do you know which treatment to use for uncomplicated dyspepsia
endoscopy is best for effect of symptoms but not cost effective
what are the common causes of peptic ulcer
H pylori 5% of cases non-steroidal and aspirin
what are the more rare causes of peptic ulcer
zollinger-ellison syndrome
crohns disease
what is the relationship between helicobactor and peptic ulcer
casually implicated in the disease
60% gastric and 80% duodenal ulcer as well strong association with gastric cancer
how was helicobactor eradicated
PPI’s and 2 antibiotics
how does H pylori fester in the stomach
bacterium produces urease which turns urea into ammonia and water which neutralises stomach acid for survival
