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Gastro > Gastric hormones > Flashcards

Gastric hormones Flashcards

1
Q

Things that increase gastrin secretion

A

Antrum distension
presence of peptides
hypercalcaemia
vagal stimulation

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2
Q

Things that inhibit gastrin secretion

A 
acid in stomach
VIP
somatostatin
GIP
glucagon
calcitonin
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3
Q

CCK role is what?

A

regulation of pancreatic enzyme secretion

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4
Q

Gastrin produced where?

A

G cells in stomach ANTRUM

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5
Q

Side effects of PPIs?

A

CAP increased risk RR 1.89 /aspiration strep pneumo
Gastro rates from campylobacter and salmonella, C diff RR2.9
Osteoporosis - but conflicting evidence

Unclear if interacts with clopidogrel, probably ok
post HOC analyses no impact on CV events

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6
Q

What causes hypergastrinaemia? (clinical states)

A 
Prolonged acid inhibition
Zollinger ellison
Vagotomy or small bowel resection
Atrophic gastritis (pernicious anaemia or H pylori)
Renal failure
Hypercalcaemia
Hyperlipidaemia (but artifactual)
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7
Q

Zollinger ellison associated with what endocrine syndrome?

A

MEN1 in 1/3 cases (parathyroid hyperplasia, pituitary and pancreatic tumours)
Chromosome 11q13

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8
Q

How do you diagnose Zollinger Ellison?

A

Fasting gastrin over 1000
Gatate PET-CT the new TEST OF CHOICE
Can also do secretin provocation looking for rise over 200

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9
Q

Statin and fibrate effect on risk of pancreatitis?

A

statin reduce risk in hypercholesterolaemia

fibrate INCREASE risk in hypertriglyceridaemia

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10
Q

Do cessation of smoking and alcohol reduce the long term risk of chronic pancreatitis after first episode?

A

smoking yes

drinking no

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11
Q

New evidence that ERCP pancreatitis can be effectively prevented with what?

A

NSAID suppository

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12
Q

What is the gene and defective gene product in hereditary pancreatitis?

A

autosomal dominant
Trypsinogen gene PRSS1
Recurrent mild attacks from age 5

SPINK1 mutation, CFTR mutation other causes, chymotrypsin C

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13
Q

What is the pathology behind autoimmune pancreatitis?

A 
IgG4 disease
Recurrent mild attacks, can also present with a mass and look like cancer- sausage shaped panc mass
Associated with RA, sjogren's PBC
RAISED SERUM IgG4
Responds to steroids! Sometimes need AZA
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14
Q

How do you show successful eradication of H pylori?

A

6 weeks post end regimen breath test. PPI off one week

If fails, clarithromycin resistance, or metro resisitance
Can try amox, moxiflox, omep

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15
Q

Symptoms of eosinophilic oesophagitis:

A

dysphagia
food impaction
chest/abdo pain
refractory GORD

histo: oesophageal eosinophilia- don’t have ANY normally!!
also basal zone hyperplasia

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16
Q

Eosinophilic hypersensitivity is associated with what drug side effect in asians?

A

Carbamazepine hypersensitivity syndrome!!!

17
Q

New treatment for eosinophilic oesophagitis

A

six food elimination diet! –>81% histo remission
most common trigger is milk and wheat
Take away all 6 for 8 weeks then reintroduce slowly
don’t do skin prick testing- useless
Nuts wheat soy eggs seafood milk

there is also a subtype that get better on PPIs ?anti-inflammatory effects-usually do this first now

can also swallow budesonide - gross

18
Q

What is achalasia?

A

failure of relaxation of lower oesophageal sphincter

  • in type 1 there is no relaxation of LES
  • in type 2 there is no relaxation or peristalsis, the whole thing just pushes in; less response to surgery
19
Q

If you see a barium swallow with small bowel with crazy looking valvulae conniventes- think what?

A

Small bowel diverticulae strongly associated with bacterial overgrowth.
Can see wt loss, B12 def, folate def, positive hydrogen breath test.
Scleroderma can do a similar thing,.

20
Q

What does HLA DQ2 DQ8 do in coeliac?

A

Useful to rule OUT

21
Q

diagnose coeliac…need 5 of 6 of…

A

typical symptoms of celiac disease; positivity of serum celiac disease immunoglobulin, A class autoantibodies at high titer; human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes; celiac enteropathy at the small bowel biopsy; and response to the gluten-free diet

Really need to see improvement of the nonspecific histo findings on re-endoscopy after changing diet

22
Q

Coeliac associations

A

Dermatitis herpeteformis- arms and trunk respond to gluten free diet
Autoimmune conditions (IgA def, DM, thyroidhypo)
Down and Turner sydnrome
Liver disease

23
Q

Coeliac serology- pros and cons?

A

Anti tissue transglutaminase- sensitive (95) an IgA so not seen in def
Deamidated anti Gliadin- IgG useful in IgA def but less sensitive (90%)
Both 100% specific

Anti endomysial is IgA- 95,100 sens spec

24
Q

What are some strategies to approach indeterminate cases of coeliac?

A

Do HLA typing
Exclude other causes of atrophy- drugs like NSAIDs, MMF, olmesartan, giardia, lymphoma, overgrowth, CVID
Re-check after gluten challenge

25
Q

What gives you low resting LES tone?

A 
Gastric distension
Alcohol
Fat
Smoking
CCK
Caffeine

All the good stuff plus CCK

26
Q

Severity of reflux oesophagitis at endoscopy dependent or independent of degree symptoms?

A

Independent - so reason for doing the scope is to check for complications like Barrets and red flags

BUT Barretts DOES correlate with duration of symptoms

27
Q

Does H pylori cause GERD?

A

No

28
Q

What do you have to make sure before considering for nissen fundoplication?

A

Prove that there is reflux with pH monitoring

Prove that there is no achalasia- resting LES under 10 mmHg

29
Q

What is the epithelial change in barrett’s esophagus?

A

squamous to columnar epithelium

30
Q

What are the recommendations for Barrett’s surveillance?

A

Barrett’s itself doesnt matter, just worried if get dysplasia
No dysplasia: surveillance endoscopy every 3-5 years
Low grade dysplasia: 6 monthly biopsies
High grade dysplasia: this is basically cancer. Surveillance and biopsy every three months; or resection or ablation to be considered if young.

31
Q

Get into head- different risk factors for different types of oesophageal cancer:

A

Adeno- Barrett’s

Squamous- smoking (and alcohol)

32
Q

Coeliac complications

A

Anaemia: iron, B12, folate (folate more common than B12)
Hyposplenism
Osteoporosis, osteomalacia
Lactose intolerance
Enteropathy associated T cell lymphoma of the small intestine
Subfertility
Oesophageal cancer (rare)

Gastro (12 decks)

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