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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
Q

4 treatments offered for Barrett’s oesophagus

A

acid suppression
monitoring
ablation
surgery

26
Q

where are gastric ulcers most commonly found

A

in the lesser curvature of the stomach

27
Q

what 3 effects does h pylori have on gastric secretion

A

decreased somatostatin
increased gastrin
increased acid

28
Q

4 red flags for PUD

A

1) haematemesis/malena
2) anorexia
3) dysphagia
4) back pain (penetration to pancreas)

29
Q

investigations for PUD

A

13C urea breath test (HP)
if any red flags endoscopy
stool test

30
Q

2 complications of PUD

A

haemorrhage

perforation

31
Q

3 symptoms of gastric haemorrhage

A

haematemesis/malena
shock and low BP
low Hb

32
Q

signs and symptoms of gastric perforation

A

peritonitis -> sudden onset abdo pain
collapse
shock
pneumoperitoneum

33
Q

what stimulates G cells

A

vagus nerve
gastric stretching
peptides/aa’s in the stomach

34
Q

what do G cells secrete and what inhibits them and where are they found

A

gastrin
inhibited by low pH
in the antrum of the stomach

35
Q

what do the D cells of the stomach (and hypothalamus) produce

A

somatostatin

36
Q

what 7 agents are inhibited by somatostatin

A 
gastrin
CCK
secretin
motilin
VIP
GIP
HCl
37
Q

which cell secretes histamine and what effect does it have

A

enterochromaffin cells

stimulates H+ secretion

38
Q

what do chief cells secrete

A

pepsinogen and chymosin

39
Q

what do parietal cells secrete

A

acid

intrinsic factor

40
Q

where in the stomach is the highest conc of parietal cells

A

in the isthmus

41
Q

where are G and D cells located in the stomach

A

the antrum

42
Q

what physical effects do somatostatin produce

A

decreased gastric emptying
decreased sm muscle contraction and bf in the intestine
decreased acid produced by parietal cells

43
Q

what does gastrin do

A

stimulate acid production in parietal cells

stimulate bile production

44
Q

what is the name of a gastrin producing tumor

A

Zollinger-Ellison syndrome

45
Q

when is pain most commonly associated with PUD

A

1-3 hours post prandial and lying down at night

46
Q

what is the common presentation of pyloric stenosis

A

high volume non-bilious vomiting

often with recognisable undigested food

47
Q

what causes pyloric stenosis in adults

A

PU in the pyloric canal

48
Q

what is peptic ulcer disease

A

surface breach of mucosal lining of GI tract as a result of acid/pepsin attack

49
Q

3 types of dyspepsia

A

post prandial fullness
early satiation
epigastric pain/burning

50
Q

what might be the symptoms for a duodenal ulcer

A

epigastric pain radiating to the back
relieved by food
symptoms persist for a few weekend then may be symptomless
in younger pts

51
Q

what might be the symptoms of a gastric ulcer

A

severe pain after meals

in older puts (50-65)

52
Q

A.L.A.R.M. symptoms

A 
anaemia
loss of weight
recent onset of symptoms
malaena
swallowing difficulty
53
Q

most common cause of PUD

A

h pylori

54
Q

4 risk factors for barrettes oesophagus

A

GORD
white
male
obese

Nutrition (11 decks)

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