GORD and gastric ulcers

Question 1

what causes GORD?

Answer 1

the relaxation of the lower oesophageal sphincter (LOS) in absence of swallowing

Question 2

what glands in the stomach release gastric acid?

Answer 2

oxyntic glands

Question 3

how do H+ ions enter the stomach ?

Answer 3

CO2 diffuses into pareteral cells from the blood plasma and is hydrated into carbonic acid which dissociates into HCO3- and H+ ions, HCO3- enters the blood stream and H+ ions then move into the stomach via the H+/K+ proton pump transporter on the basolateral membrane, Cl- and K+ return to the lumen and HCl is made

Question 4

give 3 positive regulators of gastric acid secretion?

Answer 4

• acetylcholine
• histamine
• gastrin

Question 5

describe the stages of gastric acid secretion?

Answer 5

• cephalic: after the thought, smell or sight of food
• gastric: when food enters the stomach, peptides in the food stimulate G cells which release gastrin to stimulate the release of HCL
• intestinal: chyme enters the duodenum and activates D cells which secrete somatostatin and inhibits HCL increasing the PH

Question 6

what is secreted by the pyloric region of the stomach?

Answer 6

both gastrin and mucus

Question 7

what process inside the stomach creates a protective barrier?

Answer 7

secretion of alkaline rich fluid from the pyloric glands

Question 8

what are the symptoms of GORD?

Answer 8

heartburn

Question 9

what is a red flag symptom of GORD?

Answer 9

difficulty swallowing

Question 10

what is the difference between gastric and duodenal ulceration?

Answer 10

gastric ulceration is caused by damage to the epithelium whereas duodenal ulceration is caused by an increase in acid production

Question 11

what Bacteria caused peptic ulceration?

Answer 11

H.Pylori

Question 12

how do NSAIDS (e.g ibuprofen) cause gastric ulcers?

Answer 12

NSAIDS decrease prostaglandin production, the role of prostaglandin is to inhibit gastric acid secretion and increase mucosa secretion

Question 13

give 3 symptoms of gastric ulceration?

Answer 13

• upper abdominal pain
• feeling uncomfortably full
• bloating
• heartburn

Question 14

give 2 red flag symptoms of gastric ulceration and what may be causing this?

Answer 14

unexplained weight loss, black or red or tarry stools, this may be caused by a GI bleed

Question 15

give 2 non medical pieces of advice for GORD / ulceration?

Answer 15

• weight loss
• reduce fatty food intake

Question 16

what is first line treatment for GORD and ulceration if no H.Pylori is present?

Answer 16

proton pump inhibitor e.g omeprazole, lansoprazole

Question 17

what dose of omeprazole and lansoprazole should be given for first line GORD/ULC treatment?

Answer 17

omeprazole = 20mg OD 4w
lansoprazole = 30mg OD 4w

Question 18

what is second line treatment for GORD and ulceration if no H.Pylori is present?

Answer 18

H2 receptor antagonist e.g famotidine twice daily

Question 19

what treatment is given for stomach ulceration when H.Pylori is present?

Answer 19

• PPI
• amoxicillin
• clarithromycin
  (one PPI, 2 antibiotics)

Question 20

what antacid has laxative properties?

Answer 20

magnesium hydroxides

Question 21

what antacids have constipation risks?

Answer 21

aluminium hydroxides

Question 22

why does H.Pyori give patients ammonia smelling breath?

Answer 22

H.Pylori creates urease which breaks down urea into carbon dioxide and ammonia