Peptic ulcer disease Flashcards

1
Q

Protection

A

Alkaline mucus
Tight junctions between epithelial cells

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2
Q

Peptic ulcers

A

Higher rate in men than women
15% patients die from ulcer perforation

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3
Q

Peritonitis

A

Bacteria living in stomach and infection rapidly spread into blood
Risk of multiple organ failures

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4
Q

Stomach

A

Alkaline mucus secrete alkaline mucus that Forms thin layer over luminal surface
Mucus content neutralises H+ in epithelium

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5
Q

Peptic ulcer disease factors affecting Acid/Pepsin

A

Helicobacter pylori
Smoking
Genetic factors
Stress

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6
Q

Peptic ulcer disease factors affecting mucosal defence

A

Smoking
Genetic factors
NSAIDs

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7
Q

Gastric ulceration

A

More common in women
Avoid food, hence lose weight

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8
Q

Duodenal ulceration

A

More common in men
No weight loss

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9
Q

Protective factors

A

Bicarbonate layer
Mucus
Blood flow
Cell renewal
Prostaglandins
Phospholipids

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10
Q

Damaging factors

A

Acid
Pepsin
Bile salts
Drugs NSAID
H. pylori

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11
Q

Warning signs

A

Iron-deficient
Anaemic
Chronic blood loss
Weight loss
Progressive dysphagia
Persistant vomiting

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12
Q

H. Pylori stats

A

40% infected
95% gastric ulcer
80% duodenal ulcer

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13
Q

H. Pylori

A

Survives in microaerophil
Infects lower part of stomach
Inflammation of gastric mucosa (asymptomatic)
Colonises antrum of stomach

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14
Q

H. Pylori in stomach

A

Uses Flagella to burrow into mucus lining of stomach where pH is more neutral
Moves towards less acidic environment (chemotaxis)
Adheres to epithelial cells by producing adhesins, bind lipids and carbohydrates
BabA binds to Lewis b antigen displayed
SabA binds to increased levels of sialyl-Lewis x antigen
Produces urease to neutralise acid in stomach

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15
Q

Diagnostic testing for H. pylori

A

Serologic evaluation of antibodies
Urea breath test (UBT)
Stool antigen test (SAT)

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16
Q

UBT

A

Patients swallow a capsule containing urea made from isotope of carbon. Urea broken down and turned into CO2 and excreted through breath

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17
Q

Gastric gland in the stomach

A

Fundus
Body: mucus, pepsinogen, HCL
Antrum: mucus, pepsinogen, gastrin

Contain enterochromafin-like cells: paracrine and histamine
D cells: peptide somatostatin in antral region

18
Q

Cells of the stomach

A

Parietal oxyntic cells: secrete acid, intrinsic factor
ECL cells: histamine
Chief cells: secrete pepsinogen

19
Q

Canaliculi

A

Luminal membranes of parietal cells
increase surface area for secretion

20
Q

Parietal cells

A

Activated by acetylcholine (M3 receptor) or gastrin (CCK-B receptor), increase intracellular calcium concentration, stimulates acid secretion from proton pump on canalicular surface.

21
Q

Enterochromafin-like cells

A

Stimulate histamine release resulting in activation of adenyl cyclase > increases cAMP and activates protein kinases > proton pump.

22
Q

Gastrin

A

Secreted by antral G cells
Passes from blood vessels into submucosal tissue of fundic glands, binds to gastrin-CCK-B receptors and ECL cells.

23
Q

Prostaglandin neurones

A

Vagus nerve stimulates prostaglandin neurones of enteric system to release ACh, binds to M3 receptors

24
Q

Histamine

A

ECL cells by gastrin (CCK-B receptors)
Acetylcholine (M3 receptors)

25
Q

Acid in stomach

A

Carbonate exchanged for chlorine
Chlorine diffuses into lumen through CIC channel
Increased K+ hyperpolarises the membrane potential

26
Q

Treating peptic ulcer disease

A

Antacids
Raising gastric acid pH (>3)
Eradication of H. pylori infection
Antisecretory agents

27
Q

Histamine receptor antagonists (H2)

A

Cimetidine
Ranitidine
Nizatidine
Famotidine

28
Q

H2 antagonists actions

A

Act on parietal cells
Reduce acid secretion by 60%
Treat duodenal and gastric ulcers
Relapse common after treatment

29
Q

H2 antagonists MOA

A

Histamine released from ECL by gastrin/vagal stimulation is blocked

30
Q

H2 antagonists side effects

A

Diarrhoea
Headache
Confusion in elderly

31
Q

Cimetidine

A

Gynaecomastia (anti-androgen effect)
Inhibits CYP450
Potential interactions with Warfarin, Phenytoin, Theophylline

32
Q

Proton Pump Inhibitors

A

Omeprazole
Lansoprazole
Pantoprazole
Rabeprazole
Esomeprazole

33
Q

PPIs chemistry

A

Irreversible inhibitors of proton pump
Bind covalently via disulphide bond
90% acid production inhibition

34
Q

PPIs side effects

A

GI upset
Headache
Skin rashes
Long term - gastric atrophy

35
Q

Omeprazole

A

Stimulates and inhibits CYP450
Reduces elimination of diazepam, phenytoin and warfarin - inhibition of hepatic metabolism

36
Q

H. pylori medications

A

PPI
Amoxicillin
Clarithromycin/metronidazole (twice daily for a week)

Combination antibiotic therapy for severe cases

37
Q

Misoprostol

A

Enhanced duodenal bicarbonate secretion
Increased mucosal blood flow
Not used in pregnancy (induces abortion)

38
Q

Zollinger-Ellison Syndrome

A

Rare disorder causing ulcers
Caused by non-beta islet cell

39
Q

GORD

A

Normal acid secretion
Incompetent lower oesophageal sphincter

40
Q

Treating GORD

A

Antacid and alginates
H2 antagonist
PPI
Laparoscopic surgery if severe

41
Q

Barrett’s oesophagus

A

Long term GORD
Replacement of stratified squamous epithelium by columnar epithelium with goblet cells