Peptic Ulcer

Question 1

What is peptic ulcers and what causes it?

Answer 1

Peptic ulcers are open sores that develop in the inside lining of the stomach and upper portion of the small intestines.
Causes:
Helicobacter pylori bacteria(H.pylori)
Zollinger-Ellison Syndrome (ZES)
Drugs:NSAIDs causes drug interactions

Question 2

What are the signs and symptoms of peptic ulcers?

What is Gastrin?

Answer 2

Epigastric pain, Nausea, Vomiting, Belching, Significant Weight Loss, Pain or discomfort in the upper abdomen, Dark stools

Gastrin is a peptide hormone that stimulates gastric acid secretions from the parietal cells of the stomach and this aids motility.

Question 3

Explain H.pylori and ZES?

Answer 3

H.pylori bacteria
It damages the mucous that protects the stomach and the small intestine exposing the stomach to burns.
ZES
It is a rare condition that affects the GIT. It is characterised by forming tumors( gastrimoas) which produces excessive amount of Gastrin. Gastrin in turns triggers over production of gastric acid (HCl).

Question 4

How can peptic ulcers be diagnosed?

Answer 4

Endoscopy
Stool test
Pleural breath test
Blood test
Biopsy

Question 5

Classifications of drugs used for treatment of peptic ulcers?

Answer 5

Antacids: Aluminum Hydroxide, Magnesium Hydroxide (Mix-mag), Calcium Carbonate, Sodium Bicarbonate
Drugs used to provide physical barriers: Sucralfate, Misoprostol, Bismuthsubsalicylate.
Drugs used to decrease acid secretions: Proton pump inhibitors (PPI); Omeprazole, Esomeprazole, Lansoprazole
H² receptor blockers: Cimetidine, Ranitidine

Question 6

What is the recommended therapy for H.pylori?

Answer 6

P.P.I +Amoxicillin+Clarithromycin

Question 7

What are antacids, their MOA?

Answer 7

Antacids are drugs which are bases that causes neutralization reaction in the stomach and relieve is provided because the free H ions of the acidic secretions is binded to by the bases.

Question 8

NOTE

Answer 8

Constipation is commonly associated with Aluminum Hydroxide and Calcium Carbonate, whereas diarrhoea is common treated using Magnesium Hydroxide.

Question 9

Drugs that provide physical barriers and their side effects?

Answer 9

This drugs exert cytoprotective effects on the stomach mucosa.
Misoprostol, Sucralfate, Bismuthsubsalicylate
Side effects of Misoprostol
Nausea, Vomiting, Head ache, Cardiac arrhythmia
Side effects of Sucralfate
Dry mouth, Back pain, Dizziness
Side effects of Bismuthsubsalicylate
Black tongue, Black Stool

Question 10

What are the contraindications to using Drugs that provide cytoprotective effects on the mucosa?

Answer 10

Contraindications for Misoprostol
Pregnancy, Cardiovascular diseases, Hepatic and Renal disease
Contraindications for Sucralfate
Renal disease
Contraindications for Bismuthsubsalicylate
Adult client taking aspirin

Question 11

Drugs which are used to decrease acid secretions (proton-pump inhibitors) ; MOA and side effects?

Answer 11

Omeprazole, Esomeprazole, Lansoprazole
This drugs work by inhibiting the enzyme responsible for Gastrin secretions. The enzyme is pepsin.
The side effects of this drugs are headache, diarrhoea, constipation, abdominal pain, nausea.