peptic ulcer disease and acid reflux

Question 1

why should you not give meds on empty stomach

Answer 1

stomach lumen is shrunk when empty

Question 2

hiatus hernia

Answer 2

hole in the diaphragm which the oesophagus goes through the the oesophagogastric mucosal junction may move
acid may come up and damage the squamous epithelium of the oesophagus

Question 3

G cells release

Answer 3

gastrin

Question 4

gastrin stimulates

Answer 4

parietal cells

Question 5

parietal cells make

Answer 5

acid

Question 6

antrum senses

Answer 6

pH

Question 7

D cells secrete

Answer 7

somatostatin

Question 8

somatostatin

Answer 8

switch of G cells

Question 9

helicobacter

Answer 9

causes inflammation and somatostatin is suppressed

therefore G cells are always uninhibited so gastrin is constantly produced and acid is excessively produced

Question 10

GORD

Answer 10

gastro-oesophageal reflux disease

Question 11

peptic ulcers occur where

Answer 11

acid is present

Question 12

toxins produced by helicobacter pylori

Answer 12

CagA and VacA
make inflammation
duodenal ulcer and adenocarcinoma may result from toxin producing helicobacter

Question 13

H pylori non toxin producing

Answer 13

regardless of toxin status, H pylori infection is always associated wth a degree of histological gastritis (inflammation)

Question 14

pepto-bismol

Answer 14

contains bismuth which is kills spirochetes (helicobacter) and heals ulcers

Question 15

bismuth

Answer 15

same group in the periodic table as arsenic

Question 16

bismuth citrate

Answer 16

used in Australia

Question 17

intestinal metaplasia

Answer 17

sign of chronic inflammatory
sign of gastric cancer risk
cancer probably develops at the edge of islands of intestinal metaplasia

Question 18

H pylori does not grow

Answer 18

where there is intestinal metaplasia

Question 19

chronic inflammation due to HH pylori causes formation if

Answer 19

intestinal metaplasia

Question 20

distribution of helicobacter

Answer 20

wisespread infection - lower acid secretion
antrum only infection - acid secreting part of the stomach is minimally inflamed and overproduces acid due to excessive gastrin secretion

Question 21

widespread helicobacter infection

Answer 21

not likely to experience excessive acid secretion

Question 22

antrum only infection symptoms

Answer 22

may have duodenal ulcer
hiatus hernia
heartburn /acid reflux

Question 23

Proton pump inhibitor

Answer 23

reduces acid

if acid is not reduced the cure rate is low

Question 24

if acid is not removed in duodenal ulcer patients

Answer 24

cure rate is low

must treat with antibiotic and also proton pump inhibitor

Question 25

antacids

Answer 25

most common acid reduction therapy

• need too much to heal ulcers
• eg. mylanta
• cause calcium/aluminium salts with constipates the patient
• magnesium salts loosen stools
• interferes with gastric absorption of many drugs e.g antibiotics
• can interfere with absorption and cause malnutrition

Question 26

gaviscon granules

Answer 26

1-2 tablets prn, bedtime

- alginic acid, aluminium hydroxide, Na bicarbonate

Question 27

antacid tablets

Answer 27

1-2 tabs chewed prn
quick-eye, tums, mylanta
- chew, leave antacid in the oesophagus, quick relief

Question 28

mucosal protective agents

Answer 28

thickens/strengthens mucus
antacid which makes the mucus less permeable
can cause black stool

Question 29

proton pump inhibitors act on

Answer 29

H+ K+ ATPase

Question 30

histamine stimulates

Answer 30

H2 receptor

Question 31

H2 receptor is located

Answer 31

on a parietal cell

Question 32

when H2 receptor is stimulates

Answer 32

gastric acid is secreted

Question 33

H2 receptor antagonists

Answer 33

cimetidine, ranitidine, famotidine
competitive inhibitors of the H2 receptor
well absorbed with few side effects
renal excretion dn liver metabolism, short half life

Question 34

cimetidine

Answer 34

competitive H2 receptor inhibitor

inhibits c-P450

Question 35

why does it take a lot of acid suppression to rate pH

Answer 35

99.9% acid suppression needed to raise pH 1.5-4.5 due to logarithmic scale

Question 36

ulcer therapy

Answer 36

acid reduction heals 90%

but will relapse unless the underlying problem is treated

Question 37

duodenal ulcer most often occur in

Answer 37

younger people, high acid secretion, replapse quickly

Question 38

gastric ulcers occur in

Answer 38

older people, slower to heal

Question 39

proton pump inhibitor examples

Answer 39

esomeprazole - Nexium 
bind to -SH groups in the ATPase 
non-competitive binding 
- total inhibition of acid secretion 
- long action

Question 40

P-cab based acid blocker

Answer 40

potassium competitive acid blockers
long half life
more complete acid blockade than proton pump inhibitors
more effective in resistant H pylori

Question 41

drugs used to eradicate H pylori - those that can never cause resistance

Answer 41

amoxicillin, bismuth, tetracycline

Question 42

drugs used to eradicate H pylori - those that always cause resistance

Answer 42

clarithromycin, metronidazole

Question 43

acid lowering and mucosal drugs to use with the antibiotic

Answer 43

proton pump inhibitor
H2-blocker
mucosal agents

Question 44

most commonly used triple therapy for H pylori

Answer 44

esomeprazole
amoxicillin
clarithromycin

Question 45

when H pylori triple treatment fails

Answer 45

usually due to clarithromycin resistance