GERD

Question 1

Initiators of SX

Answer 1

Meds:

• NSAIDs
• CCBs
• Beta agonists
• DA

Food/drink:

• Carbonation
• Chocolate
• Alcohol
• Citrus fruits
• Coffee or tea
• tomatoes

Lifestyle:

• smoking - nicotine increases acid
• obesity
• laying down after large meal
• eating too close to bed time

Question 2

Peptic Ulcer Disease

Answer 2

Anti-ulcer:

• Mucus secretions
• Bicarb – endothelial cells (buffer)
• Blood flow - maintains mucosa
• Prostaglandins - stimulate bicarb, mucus, promote blood flow, suppress gastric acid

Pro-ulcer:

• H. Pylori - gram -
• Gastric acid - necessary for ulcer
• Decreased blood flow - decrease mucus, bicarb
• NSAIDs - decreases prostaglandins
• smoking - nicotine stimulates gastric acid production

Question 3

Release of gastric acid

Answer 3

Histamine - most important

Acetylcholine - parasympathetic – rest and digest

Gastrin - released in response to distension

Question 4

Prokinetics

Answer 4

Bethanochol, metoclopramide

Strengthen LES
-increases stomach emptying by increasing frequency of contraction of small intestine

SE - CNS, sleepiness, anxiety

Cisapride - withdrawn due to cardiac arrhythmias, irregular heart beats