Session 5 - Gastric Disease

Question 1

What does GORD stand for?

Answer 1

Gastro-oesophageal reflux disease

Question 2

What are some of the anti-reflex mechanisms to prevent reflux into the lower oesophagus?

Answer 2

• Lower oesophageal sphincter
• Right crus of diaphragm acts as a sling around lower oesophagus
• angle oesophagus enters stomach (not horizontal)

Question 3

What is the major clinical feature of GORD?

Answer 3

Dyspepsia - worse when lying down, bending over and drinking hot drinks

Question 4

What lifestyle changes may be advised for a person with GORD?

Answer 4

• Weight loss
• Less smoking and drinking alcohol
• Less consumption of chocolate + fatty foods

Question 5

What medication may be prescribed to someone with GORD?

Answer 5

• Antacids such as calcium carbonate
• PPI’s such as Omeprazole
• H2 antagonists like Cimetidine

Question 6

What is peptic ulcer disease?

Answer 6

A break in the superficial epithelium penetrating down into the muscularis mucosa of either the stomach or duodenum

Question 7

How can NSAIDS potentially cause peptic ulcers?

Answer 7

• inhibit production of prostaglandins
• prevents formation of “unstirred layer”
• this normally protects the mucosa from the acidic contents of the stomach/duodenum

Question 8

Give some symptoms of peptic ulcer disease

Answer 8

• recurrent burning epigastric pain
• may have nausea and vomiting
• with GUs can get weight loss and anorexia
• may have haematemesis

Question 9

If a peptic ulcer is due to H. Pylori infection, what would be the usual treatment plan?

Answer 9

Triple Therapy:

• PPI - Omeprazole
• Antibiotics - Clarithromycin / Amoxicillin
• H2 antagonist -> Cimetidine

Question 10

Describe the Helicobacter Pylori infection

Answer 10

• Gram negative, aerobic, helical, urease producing bacteria
• resides in stomach of infected individuals

Question 11

How does the H. Pylori bacteria survive the acidic conditions of the stomach?

Answer 11

• Production of urease
• produces ammonia
• neutralises acid around the bacteria allowing to survive

Question 12

How would we diagnose a H. Pylori infection?

Answer 12

• IgG detected in serum
• C13-urea breath test
• gastric sample by endoscopy + detect histology and culture

Question 13

Name some of the gastric diseases that H. Pylori can cause.

Answer 13

• Gastritis (most common)
• Peptic Ulcer Disease
• Gastric Cancer

Question 14

How do Cimetidine and Omeprazole reduce the amount of acid secretion respectively?

Answer 14

Cimetidine: Removes amplification of Gastrin/Ach signal

Omeprazole: Prevents Protons from being pumped into parietal cell canaliculi