Peptic Ulcer Disease Flashcards

1
Q

how would you initially treat an upper GI bleed?

A
A to E assessment
A - if patent move on to B
B - could give oxygen if sats are low
C - if hypotensive, will need fluids
etc
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2
Q

if a patient came in with a bleeding peptic ulcer and was on anti-hypertensives, how might you change the dose of them while in hospital?

A

If patient is hypovolaemic from bleeding from the ulcer it is best to omit the medications while in hospital as they decrease BP further

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3
Q

How do NSAIDs contribute to peptic ulceration?

A

by inhibiting COX-1 it inhibits prostaglandins which stimulate gastric mucous secretion and maintain gastric blood flow and promote platelet aggregation

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4
Q

gaviscon is a mixture of an antacid and alginate. what does the alginate part do?

A

increases viscosity of stomach contents which reduces reflux of stomach acid into oesophagus.

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5
Q

when should antacids and alginates be taken and why?

A

after food for a prolonged effect otherwise they are cleared rapidly by the stomach

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6
Q

antacids such as aluminium salts (e.g. aluminium hydroxide) should not be taken with which classes of drugs and why?

A

NSAIDs and tetracyclines as it reduces their absorption - can give by spreading doses apart by 2hrs

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7
Q

what lifestyle and pharmacological factors can exacerbate dyspepsia?

A

smoking, alcohol, NSAIDs

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8
Q

what is the pharmacological management of non-ulcer dyspepsia?

A

PPI trial for 4-6weeks

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9
Q

you would do an upper GI endoscope for people with ALARM symptoms, what are these?

A
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Melaena
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10
Q

how would you test for helicobacter pylori?

A

urea breath test or stool antigen test

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11
Q

what is the treatment for someone with an uncomplicated peptic ulcer who is H.pylori positive?

A

eradication therapy = 7 day course of:

  • PPI + amoxicillin + clarithromycin, or
  • PPI + metronidazole + clarithromycin (if penicillin allergy)
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12
Q

what is the first line approach for someone with a peptic ulcer that is bleeding acutely?

A

ABC approach followed by endoscopic intervention:
diathermy,
clipping,
laser coagulation or,
injection with adrenaline to stop bleeding

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13
Q

what should be given post-endoscope in a person who has had a peptic ulcer bleed stopped?

A

IV PPI for 72hrs then chance to oral therapy.
This reduces re-bleeding rates and thus reduces a need for further surgery. PPIs reverse the deactivation of the coagulation system and platelet aggregation in the gut mucosa that occurs when the local pH falls below 4

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14
Q

if eradication therapy is needed for h.pylori, why should statins be omitted?

A

statins interacte with microlide antibiotics (e.g. clarithromycin)

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15
Q

if metronidazole is given for eradication therapy of h.pylori, what is it important to tell patients they must avoid?

A

avoid alcohol becasue it interacts with metronidazole. need to be 72hrs clear of metronidazole before having alcohol again

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