GI ulcers

Question 1

___ is secreted by parietal cells in gastric glands

Answer 1

HCL

Question 2

What increases cAMP via phosphorylation of enzymes that activate the proton pump?

Answer 2

Histamine

Question 3

What are two things stimulated/secreted by the vagus nerve?

Answer 3

Acetylcholine and gastrin-releasing peptide (GRP)

Question 4

____ facilitates HCL-mediated mucosal injury

Answer 4

Pepsin

Question 5

What cells stimulate HCL acid??? (5)

Answer 5

Gastrin, histamine, Ach, Gastrin-releasing peptide (GRP), Pepsin

Question 6

Where do 80% of ulcers occur in the horse because of limited resistance to HCL/pepsin?

Answer 6

Non glandular portion of esophagus

Question 7

What does the glandular portion of the esophagus secrete via its glands?

Answer 7

Hydrochloric acid, pepsin, bicarbonate, mucus

Question 8

Gastric ulcers most often occur in the ___ mucosa above the ?

Answer 8

Squamous; margo plicatus (along the lesser curvature usually)

Question 9

_____ = squamous mucosa but ______ = glandular mucosa

Answer 9

hyperkeratosis = squamous mucosa but hyperemia = glandular mucosa

Question 10

Grades of ulcers–>

Answer 10

0= normal
1= mucosa is intact but areas of hyperkeratosis
2=small single or multifocal lesions
3= large single or extensive superficial lesions
4= extensive lesions with areas of apparent deep ulcerations

Question 11

Does ulcer severity correlate with CS???

Answer 11

NOOOOO

Question 12

Treatment of Gastric Ulcers goal:

Answer 12

no acid, no ulcer…. so goal is to raise stomach acid pH greater than 4!!!

Question 13

What do we do/use to treat gastric ulcers???

Answer 13

H+ pump inhibitors (omeprazole and pantoprazole), covering/binding agents like sucralfate, histamine 2 blockers (Cimetidine, ranitidine, famotidine), PGF1 analog- misoprostol, antacids

Question 14

What is the goal of H+, K+, ATPase blockers/ proton pump inhibitors??

Answer 14

Suppress acid secretion, very effective tx and preventative drug

Question 15

What is the MOA of covering/binding agents (like sucralfate)??

Answer 15

Binds to ulcerative areas, forms a protective coating, does not need an acidic environment to be effective

Question 16

PGE1 analog MOA:

Answer 16

Acid suppression, increased mucosal blood blow, increased bicarb. DONT USE IN PREG MARES

Question 17

Antacid MOA

Answer 17

short lived, raise pH, neutralize HCL

Question 18

H2 receptor antagonist MOA (ex: Famotidine, ranitidine, cimetidine)—>

Answer 18

decrease gastric acid secretion

Question 19

Ulcers are most commonly considered “____”

Answer 19

Silent

Question 20

What part of esophagus is most protected from highly acidic environments?

Answer 20

LOWER section

Question 21

Keep the stomach full is the goal

Answer 21

//

Question 22

What is the most common area for ulcers in the horse GI?

Answer 22

= margo plicatus at lesser curvature

Question 23

Misoprostol is superior to what RX?

Answer 23

Superior to combined omeprazole and sulcrafate for healing glandular lesions in horses with clinical disease

Question 24

Do not give ____ or ____ to preg mares

Answer 24

Misoprotsol or PGE1 analogs