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Nutrition > GORD/PUD > Flashcards

GORD/PUD Flashcards

1
Q

list four examples of alginates

A

sodium bicarbonate
magnesium and aluminium salts
simeticone
sodium alginate

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2
Q

how do alginates work?

A

increase the viscosity of stomach content and reduce the symptoms of reflux

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3
Q

what side effects can occur with alginates

A

aluminium can cause CONSTIPATION

magnesium can cause DIARRHOEA

both have a high salt content

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4
Q

what drug interactions might alginates have

A

abx –> ciprofloxacin and tetracyclines

can also interfere with enteric coated preps

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5
Q

which drugs might be used to promote mucosal defence

A

misoprostol
sucralfate (complex of aluminium hydroxide and sulphated sucrose)

stimulates production of prostaglandins

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6
Q

side effects of sucralfate

A

constipation

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7
Q

drug interactions of sucralfate

A

enteral feeds –> bezoar formations
digoxin
abx
penytoin

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8
Q

side effects of misoprostol

A

diarrhoea and ado pain

induces abortion –> contraindicated in women of child bearing age

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9
Q

name two gastric stimulants which might be given to increase peristalsis in the jejunum and duodenum

A

domperidone
metoclopamide

dopamine receptor antagonists which stimulate gastric emptying and enhance the strength of oesophageal sphincter contration

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10
Q

name 4 H2 receptor antagonists

A

ranitidine
nizatidine
famotidine
cimetidine

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11
Q

what are the listed side effects of H2 receptor antagonists

A 
diarrhoea
headaches
constipation
confusion
hallucinations
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12
Q

drug interactions of H2 receptor antagonists

A

cimetidine slows P450 therefore should be avoided in patients on warfarin, phenytoin and theophylline

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13
Q

what are the potential adverse effects of PPIs

A

possible effect on WBCs –> pneumonia
rebound acid hyper secretion
increased risk of c diff infection
interactions (omeprazole and clopidigrel)
can affect Ca absorption –> increased fractures

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14
Q

what are the first and second line treatments for H pylori infection

A

first: triple= PPI, amox/metranidazole and clarithromycin

in second line treatment metronidazole is preferential

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15
Q

three structural abnormalities which can lead to GORD

A

poor oesophageal peristalsis
incompetent LOS
hiatus hernia

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16
Q

4 risk factors for GORD

A

obesity
diet
smoking
NSAIDS

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17
Q

3 investigations for GORD

A

FBC
Barium swallow
pH monitoring

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18
Q

endoscopy is used for what in the investigation of GORD

A

looking for Barret’s oesophagus (+biopsy) or cancer

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19
Q

name 2 substances which cause oesophagitis in GORD

A

Acid

pepsins

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20
Q

what is the symptom of oesophageal stricture and in what age group does it occur

A

gradual onset dysphagia in the over 60s

caused by oesophagitis in 10% of cases

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21
Q

which type of cancer does Barrett’s lead to

A

adenocarcinoma following intestinal columnar metaplasia

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22
Q

which type of cancer does chronic inflammation of the oesophagus lead to

A

squamous cell carcinoma

23
Q

list 4 stages of Barrett’s OE

A
  1. Erosive oesophagitis
  2. Metaplasia
  3. Dysplasia if intestinal columnar epithelium present (low grade= tissue maintains form; high grade = tissue loses form)
  4. Neoplasia (adenocarcinoma)
24
Q

Which gene causes intestinal epithelium to become dysplastic

A

switching on of CDX-2 gene

25
4 treatments offered for Barrett's oesophagus
acid suppression monitoring ablation surgery
26
where are gastric ulcers most commonly found
in the lesser curvature of the stomach
27
what 3 effects does h pylori have on gastric secretion
decreased somatostatin increased gastrin increased acid
28
4 red flags for PUD
1) haematemesis/malena 2) anorexia 3) dysphagia 4) back pain (penetration to pancreas)
29
investigations for PUD
13C urea breath test (HP) if any red flags endoscopy stool test
30
2 complications of PUD
haemorrhage | perforation
31
3 symptoms of gastric haemorrhage
haematemesis/malena shock and low BP low Hb
32
signs and symptoms of gastric perforation
peritonitis -> sudden onset abdo pain collapse shock pneumoperitoneum
33
what stimulates G cells
vagus nerve gastric stretching peptides/aa's in the stomach
34
what do G cells secrete and what inhibits them and where are they found
gastrin inhibited by low pH in the antrum of the stomach
35
what do the D cells of the stomach (and hypothalamus) produce
somatostatin
36
what 7 agents are inhibited by somatostatin
``` gastrin CCK secretin motilin VIP GIP HCl ```
37
which cell secretes histamine and what effect does it have
enterochromaffin cells | stimulates H+ secretion
38
what do chief cells secrete
pepsinogen and chymosin
39
what do parietal cells secrete
acid | intrinsic factor
40
where in the stomach is the highest conc of parietal cells
in the isthmus
41
where are G and D cells located in the stomach
the antrum
42
what physical effects do somatostatin produce
decreased gastric emptying decreased sm muscle contraction and bf in the intestine decreased acid produced by parietal cells
43
what does gastrin do
stimulate acid production in parietal cells | stimulate bile production
44
what is the name of a gastrin producing tumor
Zollinger-Ellison syndrome
45
when is pain most commonly associated with PUD
1-3 hours post prandial and lying down at night
46
what is the common presentation of pyloric stenosis
high volume non-bilious vomiting | often with recognisable undigested food
47
what causes pyloric stenosis in adults
PU in the pyloric canal
48
what is peptic ulcer disease
surface breach of mucosal lining of GI tract as a result of acid/pepsin attack
49
3 types of dyspepsia
post prandial fullness early satiation epigastric pain/burning
50
what might be the symptoms for a duodenal ulcer
epigastric pain radiating to the back relieved by food symptoms persist for a few weekend then may be symptomless in younger pts
51
what might be the symptoms of a gastric ulcer
severe pain after meals | in older puts (50-65)
52
A.L.A.R.M. symptoms
``` anaemia loss of weight recent onset of symptoms malaena swallowing difficulty ```
53
most common cause of PUD
h pylori
54
4 risk factors for barrettes oesophagus
GORD white male obese

Nutrition (11 decks)

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