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MP322 > Peptic ulcer disease and GORD > Flashcards

Peptic ulcer disease and GORD Flashcards

1
Q

Peptic ulcer

A

umbrella term for gastric and duodenal ulcers

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2
Q

Alkaline mucus

A

alklaline ulcer close to surface of epithelial cells which neutralises acid in small area of stomach

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3
Q

Peptic ulcer PROTECTION

A
  • Alkaline mucus
  • Tight junctions between epithelial cells
  • Replacement of damaged cells every few days
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4
Q

Peptic ulcer CAUSES

A
  • Acid and pepsin
  • Heliobacter pylori infection
  • Drugs - NSAID use
  • Lifestyle factors - alcohol, smoking
  • Severe physiologic stress
  • Hypersecretory state
  • Genetic factors
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5
Q

Impaired mucosal defence

A

NSAIDs inhibits cyclo-oxygenase stopping production of prostaglandins which weakens mucosal defence

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6
Q

Peptic ulcer SYMPTOMS

A
  • Abdominal discomfort, pain or nausea
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7
Q

Pain (peptic ulcer)

A

located in epigastrium and usually does not radiate
- burning, gnawing or hunger pains

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8
Q

Gastric ulcer pain

A

aggravated by meals

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9
Q

Duodenal ulcer pain

A

relieved by meals

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10
Q

Peptic ulcer DIAGNOSIS

A

X-ray - taken of abdomen, only shows if >5mm
Endoscopy - patient sedated, lying on side, insert long flexible camera down through mouth into the stomach

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11
Q

H.pylori

A

95% gastric ulcer
80% duodenal ulcer
infects lower part of stomach (antrum)
causes inflammation of gastric mucosa (gastritis)

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12
Q

H.pylori DIAGNOSIS

A

serologic evaluation
urea breath test
stool antigen test

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13
Q

Serologic evaluation

A

presence of H.pylori antibodies

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14
Q

Urea breath test

A

H.pylori contains large amounts of enzyme urease = urea -> NH3 and CO2
- exhaled breath containing CO2 13 isotope = positive for H.pylori

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15
Q

Stool antigen test

A

detect antigen release by organism present in stomach = active infection

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16
Q

Failure to eradicate H.pylori

A

80% of ulcers will reoccur within a year

16
Q

Histamine

A

comes from Enterochromaffin like cells
- stimulated by gastrin (hormone) or acetylcholine

16
Q

Acid in lumen

A

canaliculi structures have proton pumps on surface - increase surface area and allows parietal cells to secrete acid

17
Q

Examples of H2 receptor antagonists

A

cimetidine, ranitidine, nizatidine, famotidine

17
Q

Parietal cells

A
  1. Carbonic anhydrase produces HCO3- and H+
  2. HCO3- is exchanged for Cl-
  3. Cl- diffuses into lumen
  4. H+ is pumped into lumen by H+/K+ ATPase
    = acid in lumen
18
Q

H2 antagonists

A

act competitvely on H2 receptors on gastric parietal cells
- reduce basal acid secretion by 80%
- can treat both duodenal and gastric ulcers but relapse is common after treatment

19
Q

Adverse effects of H2 antagonists

A

diarrhoea
headache
confusion in elderly
gynaecomastia with cimetidine (anti-androgen effect)

20
Q

Cimetidine

A

inhibits CYP450
- interactions with WARFARIN, PHENYTOIN and THEOPHYLLINE

21
Q

Examples of proton pump inhibitors

A

omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole

22
Q

PPIs

A

inhibition of pump almost completely blocks acid secretion (irreversible)
- acid secretion inhibited by 90% for 24 hours with single dose
-> dependent on new enzymes to return acid secretion

23
Q

Adverse effects of PPIs

A

GI upset eg. epigastric, discomfort, nausea and vomiting, diarrhoea
headache
skin rashes

24
Q

Omeprazole

A

stimulatory and inhibitory effects on CYP450
- long term use = gastric atrophy

25
Q

Eradication of H.pylori infection

A

PPI, amoxicillin and either clarithromycin or metronidazole
- allergic to penicillin = PPI, clarithromycin and metronidazole

26
Q

Cytoprotective agents

A

MISOPROSTOL (methyl analogue of prostaglandin E1)
enhanced duodenal bicarbonate secretion
- weak inhibition of acid secretion through prostaglandin receptors on parietal cells = increased mucosal blood flow
MUST NOT BE USED IN PREGNANCY

27
Q

Zollinger-ellison syndrome

A

rare disorder - gastric or duodenal ulcers as well in jejunum
massive gastric acid HYPERSECRETION
- due to gastrin secreting tumour in pancreas or duodenum (gastrinoma) that stimulates acid secretion in stomach

28
Q

GORD

A

gastro-oesophageal reflux disease

29
Q

GORD CAUSES

A

functionally incompetent lower oesophageal sphincter
- allows reflux of gastric contents (acid and pepsin into oesophagus)

30
Q

GORD SYMPTOMS

A

retrosternal burning

31
Q

Peptic ulcer TREATMENT

A

H2 antagonists
PPIs

32
Q

GORD TREATMENT

A

Antacids and antacid/alginate combinations
H2 antagonists and PPIs

33
Q

Antacid

A

neutralises stomach acid

34
Q

Alginate

A

forms raft over stomach to prevent gastric contents entering oesophagus

35
Q

Barrett’s oesophagus

A

long-term GORD
replacement of normal stratified squamous epithelium by columnar epithelium with goblet cells
- can lead to oesophagus adenocarcinoma (cancer)

36
Q
A

MP322 (1 decks)

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