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Alim 1 > gastric acid secretion - disorders > Flashcards

gastric acid secretion - disorders Flashcards

1
Q

what is the mechanism of peptic ulcer formation

A

breakage of mucosal barriers

tissues exposed to erosion by Hcl and pepsin

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2
Q

factors responsible for acid secretion

A 
histamine
ach
gastrin
alcohol, smoking, caffeine NSAIDs
H pylori
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3
Q

risk factors for peptic ulceration

A

gastric/duodenal H. pylori infection

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4
Q

how is h pylori acquired

A

childhood - distribution and colonisation determined by environmental and host factors

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5
Q

factors that prevent infection of gastric mucosa

A 
mucus production
peristalsis
seamless epithelium - tight junctions
fast cell turnover
IgA secretion at mucosal surfaces
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6
Q

what prevents autodigestion of the stomach

A

secretion of alkaline mucus and HCO3
protein in food
tight cell junctions
prostaglandins E and I - inhibit acid secretion, enhance blood flow

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7
Q

how does h. pylori cause ulcers

A

penetrates ;) gastric mucosa, highly pathogenic with many virulence factors
increases gastrin secretion

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8
Q

virulence factors of H pylori

A

motility - moves close to epithelium

produces urease

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9
Q

what does urease do

A

converts urea to ammonia - buffers acid to allow survival of h pylori and produces CO2

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10
Q

what does gastrin do

A

stimulate HCl release

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11
Q

what does h pylori infection do to cell numbers

A

increases no of G cells, reduced number of antral D cells

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12
Q

what does the virulence factor CagA do

A

disrupt cell junctions
affects proliferation and differentiation
induces inflammation
tends to cause more severe gastritis

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13
Q

what does virulence factor VacA do

A

induces apoptosis
disrupts cell pathways
induces inflammation
modulates immune system eg allows h pylori to live in macrophages

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14
Q

what causes mucosal breakdown

A

increased gastric secretions - HCl and pepsin

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15
Q

what can aggravate peptic ulcers

A 
regurgitated bile acids
NSAIDs
genetics
smoking, alcohol, curry
h pylori
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16
Q

where are some common locations of peptic ulcers

A

duodenal cap
junction of stomach antrum and body
distal oes

17
Q

what are some diagnostic tests for suspected gastric ulcer

A 
endoscopy
histological exam
test for h pylori
stool antigen test
urea breath test
test for virulence factors
18
Q

symptoms of peptic ulcer

A 
anaemia
nausea
dyspepsia (indigestion)
vomiting, incl blood
epigastric pain
19
Q

RFs for chronic peptic ulcer

A 
hyperacidity
duodenal refluc
h  pylori
nsaids
genes
being male
20
Q

causes of acute peptic ulcer

A

develops from areas of corrosive gastritis, sever stress or shock, or acute hypoxia of surface epithelium

21
Q

outcomes of acute peptic ulcer

A

severe bleeding
healing w/o scarring
chronic peptic ulcerw

22
Q

peptic ulcer complications

A

GI haemorrhage
peritonitis
narrowing of pyloric canal

23
Q

what type of drugs are anti-secretory agents

A

h2 receptor antagonists

24
Q

clinical uses of H2 receptor antagonists

A

peptic ulcer, reflex oesophagitis

25
Q

mechanism of action for h2 receptor antagonists

A

inhibit histamine action at h2 receptors on PARIETAL cells

reduce secretion of gastrin and therefore pepsin

26
Q

unwanted side effects of H2 receptor antagonists

A

diarrhoea, muscle cramps, transient rashes, hypergastrinaemia

27
Q

side effects of cimetidine

A

gynaecomsatia in men - rare

inhibits P450 enzymes - decreased metabolism of anticoagulants and tricyclic antidepressants.

28
Q

examples of PPIs used to treat gastric ulcers

A

omeprazole, lanzoprazole

29
Q

clinical uses of PPIs

A

peptic ulcer, reflux oesophagitis

30
Q

mechanism of PPIs

A

weak bases - inactive at neutral pH and irreversibly inhibit the H+/K+ATPase pump
decreases basal and food stimulated gastric acid secretion

31
Q

drugs that protect the gastric mucosa

A

prostaglandins PGE2 and PGI2

32
Q

what is misoprostol

A

a stable analogue of PGE1

33
Q

what is the mechanism for misoprostol

A

inhibits basal and food-stimulated gastric acid secretion
inhibits histamine and caffeine induced secretion
increases mucosal blood flow and can augment the secretion of HCO3 and mucus

Alim 1 (11 decks)

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