GORD and PUD - 106

Question 0

What are red flag symptoms in GORD?

Answer 0

Dysphagia, haematemesis/Malena or anemia, weight loss.

Question 1

What are common risk factors for GORD? What investigations would be done?

Answer 1

Pregnancy, obesity, diet, lifestyle, smoking, NSAIDs.

Trial of PPIs, FBC (to exclude anemia), barium swallow, pH monitoring,endoscopy.

Question 2

What drugs are commonly used to treat GORD?

Answer 2

Antacids
Alginates(Al and Mg salts)
PPIs - e.g. omeprazole
H2 receptor antagonists - ranitidine 
Sucralphate, misoprostol - promote mucosal defences
Gastric stimulants - faster emptying

Question 3

When is misoprostol contraindicated?

Answer 3

In pregnancy.

Question 4

What side effects might Al and Mg salts cause? (Alginates used to treat GORD/PUD)

Answer 4

Al - constipation

Mg - diarrhoea

Question 5

What are risk factors for PUD and what is the most common cause of PUD?

Answer 5

Male sex, smoking, alcohol.

H. pylori - infects antrum causing decreased somatostatin production, preventing the inhibition of acid production.

Question 6

How would a patient with PUD present? What investigations would you do?

Answer 6

Haemorrhage, nausea, vomiting, iron deficiency anemia.
Medication review, FBC (anemia), H.pylori breath test and stool Ag test, endoscopy if red flags (bleeding, weight loss, dysphagia)

Question 7

What is Barrett’s Oesophagus?

Answer 7

Intestinal columnar metaplasia of the oesophagus. Potential transformation to adenocarcinoma.

Question 8

What characterises dyspepsia?

Answer 8

Early satiation, post prandial fullness and epigastric pain/burning.

Question 9

Where does referred pain from the diaphragm commonly go?

Answer 9

The shoulder.

Question 10

What condition would you give high dose H2 receptor antagonists in? (e.g. Ranitidine).

Answer 10

Zollinger-Ellison Syndrome (gastrin secreting tumour of the pancreas)

Question 11

In gastritis what can’t the body produce? What is the significance of this?

Answer 11

Can’t produce intrinsic factor. It binds Vitamin B12, so in gastritis vitamin B12 is not absorbed and patients can develop pernicious anaemia.

Question 12

What to antacids do?

Answer 12

Neutralise acid. E.g. calcium carbonate.

Question 13

What do alginates do?

Answer 13

Reduce the irritancy of acid.

Question 14

Which drugs reduce acid production?

Answer 14

PPIs e.g. omeprazole.

H2 antagonists, e.g. ranitidine.