Dyspepsia and Ulcers

Question 1

what is dyspepsia

Answer 1

complex of symptoms of the upper GI

Question 2

what are the symptoms of dyspepsia

Answer 2

upper abdominal pain
acid reflux
heartburn 
nausea 
vomiting 
bloating

Question 3

what is the initial management of dyspepsia

Answer 3

med check - NSAIDS, CS
OTC antacids, alginate may be used for immediate relief
PPI - omeprazole and H2 receptor antagonist

Question 4

what are the red flags for dyspepsia

Answer 4

unexplained weight loss
vomiting
pain on swallowing
GI bleed - stool, vomit

Question 5

what are the cause of dyspepsia

Answer 5

• Gastro oesophageal reflux disease GORD
• pepetic ulcer disease
• malignancy/cancer
• zollinger - ellison syndrome

Question 6

describe non ulcer dyspepsia

Answer 6

• H pylori

- delayed gastric emptying

Question 7

state some life style modifications

Answer 7

small freq meals 
stop smoking 
reduce alcohol 
reduce acffeine 
review meds

Question 8

what is an ulcer

Answer 8

a lesion on epithelial surface caused by superficial loss of tissue

Question 9

describe peptic ulcers

Answer 9

• ulcers in alimentary tract - stomach duodenum
• must be deep enough to penetrate the muscularis mucosa
• caused by increase acid and pepsin in gastric juice

Question 10

what are the causes of peptic ulcers

Answer 10

H pylori and NSAIDS most common

increase secretion of acid in Zollinger Ellison syndrome

Question 11

what are the two types of peptic ulcers

Answer 11

duodenal ulcer

gastric ulcer

Question 12

describe duodenal ulcer

Answer 12

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

Question 13

describe gastric ulcer

Answer 13

breakdown of gastric mucosa

• gastritis
• h pylori release cytokines
• abnormal mucus production
• parietal cell damage - low acid production

Question 14

what are the investigations that need to be carried out

Answer 14

symptoms
endoscopy for PU
radiology
urea breath test - h pylori - non invasive

Question 15

how do NASIDS damage the mucosal layer

Answer 15

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

Question 16

what are the system effects of NSAIDS

Answer 16

1. inhibit COX 1
   decrease prostaglandins which leads to increase gastric acid secretion, decrease mucous production and decrease BF
2. Inhibit COX 2
   increase intracellular adhesion molecules
   increase neutrophils adherence to endothelia cells - neutrophils lead to free radical protease - damage mucosal cells

Question 17

what are risk factors of NSAIDS

Answer 17

older than 65
past PU
high NSAID use
increase haemorrhage with anticoagulant

Question 18

proton pump inhibitors

Answer 18

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

Question 19

H2 receptor antagonist

Answer 19

cimetidine , famotidine -ine

antagonise histaime - decrease acid secretion

Question 20

anticholinergics

Answer 20

atropine

block ACh in parietal cells
many side effects