Gastrointestinal Disease

Question 1

What are the main purposes of medication used to treat Upper GI disease?

Answer 1

1. Eliminate formed acids
   - antacids
2. Reduce acid secretion
   - H2 receptor blockers
   - proton pump inhibitors

Question 2

What are the 3 main stomach acids?

Answer 2

1. Acetylcholine
2. Gastrin
3. Histamine

Question 3

What type of cell secretes stomach acid?

Answer 3

Parietal cell

Question 4

How do H2 receptor agonists reduce acid production?

Answer 4

By preventing histamine activation of acid production

Question 5

Why is the benefit of h2 receptor agonists limited?

Answer 5

Alternative pathways are still operative:

• acetylcholine
• gastrin

Question 6

What are the 2 most common H2 receptor agonists?

Answer 6

1. Cimetidine
   - original H2 blocker
   - many drug interactions
   - not fully effective
2. Ranitidine
   - not any more effective
   - safer in clinical use
   - licensed for over the counter sale

Question 7

What drug alternative is much more clinically effective at inhibiting acid secretion than H2 receptor agonists?

Answer 7

Proton pump inhibitors

• omeprazole
• lansoprazole
• pantoprazole

Question 8

Where does upper GI disease start?

Answer 8

Mid oesophagus

Question 9

What process can be used to examine the interior of the stomach and other tissues?

Answer 9

Endoscopy

- can be with a tube or a capsule

Question 10

What is the oesophageal disorder that causes difficulty in swallowing food?

Answer 10

Dysphagia

Question 11

What dysmotility disorders can also lead to dysphagia?

Answer 11

1. Fibrosis
   - scleroderma
   - acid related fibrosis (GORD - gastro osophageal reflux disease)
   . Causes chronic irritation leading to loss of specialised tissue

Question 12

What process occurs in scleroderma that leads to dysphagia?

Answer 12

Elastic tissue is replaced by fibrous tissue which no longer allows the oesophagus to contract and propel bolus

Question 13

What neuromuscular dysfunctions can lead to dysphagia?

Answer 13

1. Parkinson’s disease
2. Diabetes mellitus
3. Achalasia - nerve supply to oesophagus does not form properly

Question 14

Briefly describe dysphagia

Answer 14

1. Food sticking
   - intermittent or constant
2. Localised well by patient
3. May be ‘functional’
4. May be dysmotility
5. May be external compression

Question 15

What are the 3 main causes of Gastro Oesophageal Reflux Disease (GORD) ?

Answer 15

1. Defective lower oesophageal sphincter
2. Impaired lower clearing
3. Impaired gastric emptying

Question 16

What are the effects of GORD?

Answer 16

1. Ulceration
2. Inflammation
3. Metaplasia (gastric)
4. Barrett’s Oesphagitis
   - precancerous - adenocarcinoma

Question 17

What are signs and symptoms of GORD?

Answer 17

1. Epigastric burning
   - worse lying down, bending, pregnancy
2. Dysphagia
   - oesophagitis, stricture, dysmotility
3. GI bleeding
4. Severe pain - mimics MI
   - oesophageal muscle spasm

Question 18

Briefly describe hiatus hernia

Answer 18

1. Part of the stomach is in the thorax
   - passes up through the diaphragm
   - makes it easier for gastric contents t pass into the oesophagagus
2. Symptoms can be similar to GORD
3. More common in women
4. Multiple types
   - hiatus hernia can move through the diaphragmatic hole together with the oesophagus
   - Hiatus hernia and oesophagus can behave independently

Question 19

What are the main methods (lifestyle and medicine) that are used to treat GORD?

Answer 19

1. Lifestyle
   - smoking cessation (improves sphincter)
   - lose weight and avoid triggering activity (bending over)
2. Medication
   - antacids
   - H2 blockers and PPI’s (ranitidine and omeprazole
   - drugs that increase GI motility and gastric emptying