Dyspepsia and Ulcers Flashcards
what is dyspepsia
complex of symptoms of the upper GI
what are the symptoms of dyspepsia
upper abdominal pain acid reflux heartburn nausea vomiting bloating
what is the initial management of dyspepsia
med check - NSAIDS, CS
OTC antacids, alginate may be used for immediate relief
PPI - omeprazole and H2 receptor antagonist
what are the red flags for dyspepsia
unexplained weight loss
vomiting
pain on swallowing
GI bleed - stool, vomit
what are the cause of dyspepsia
- Gastro oesophageal reflux disease GORD
- pepetic ulcer disease
- malignancy/cancer
- zollinger - ellison syndrome
describe non ulcer dyspepsia
- H pylori
- delayed gastric emptying
state some life style modifications
small freq meals stop smoking reduce alcohol reduce acffeine review meds
what is an ulcer
a lesion on epithelial surface caused by superficial loss of tissue
describe peptic ulcers
- ulcers in alimentary tract - stomach duodenum
- must be deep enough to penetrate the muscularis mucosa
- caused by increase acid and pepsin in gastric juice
what are the causes of peptic ulcers
H pylori and NSAIDS most common
increase secretion of acid in Zollinger Ellison syndrome
what are the two types of peptic ulcers
duodenal ulcer
gastric ulcer
describe duodenal ulcer
caused by increase acid in duodenum
- increase partial cells
- increase gastrin secretion
- decrease acid secretion inhibition and increase HCO3 secretion
- smoking harming gastric mucosal healing
- genetic
describe gastric ulcer
breakdown of gastric mucosa
- gastritis
- h pylori release cytokines
- abnormal mucus production
- parietal cell damage - low acid production
what are the investigations that need to be carried out
symptoms
endoscopy for PU
radiology
urea breath test - h pylori - non invasive
how do NASIDS damage the mucosal layer
superficial erosions
can be symptomatic
erosions caused by inhibition of COX enzymes in mucosal cells
enteric coating doesn’t reduce risk but lowers superficial damage
decrease production of protective prostaglandins in mucosal cells - acid damage
what are the system effects of NSAIDS
- inhibit COX 1
decrease prostaglandins which leads to increase gastric acid secretion, decrease mucous production and decrease BF - Inhibit COX 2
increase intracellular adhesion molecules
increase neutrophils adherence to endothelia cells - neutrophils lead to free radical protease - damage mucosal cells
what are risk factors of NSAIDS
older than 65
past PU
high NSAID use
increase haemorrhage with anticoagulant
proton pump inhibitors
omeprazole
inhibit the H/K ATPase
binds to sulphydryl (-SH)
stops H from being secreted - decrease acid secretion
for ulcer treatment
enteric coating
interact with warfarin, diazepam
H2 receptor antagonist
cimetidine , famotidine -ine
antagonise histaime - decrease acid secretion
anticholinergics
atropine
block ACh in parietal cells
many side effects
