Therapeutics Upper GI

Question 1

What are antacids and how do they work?

Answer 1

Weak bases - neutralise gastric acid, decrease pepsin activity - soothing

Question 2

What are H2RA’s and how do they work?

Answer 2

Ranitidine/Cimetidine

Block histamine receptors on parietal cells = reduced PKA formation + reduced acid secretion

Question 3

What are the side effects and ADR’s of H2RA’s?

Answer 3

Side effects:
- erectile dysfunction 
- gynecomastia 
ADR's
- Cimetidine impairs warfarin metabolism

Question 4

Name some PPI’s

Answer 4

Omeprazole/Lasoprazole

More effective than antacids + H2RA’s

Question 5

What are the side effects of PPI’s?

Answer 5

• Diarrhoea, nausea, headaches

- LT = increased risk osteoporosis

Question 6

What are the stages of GORD treatment?

Answer 6

Stage 1:
- lifestyle 
- non-prescription antacids 
- H2RA as needed
Stage 2:
- H2RA therapy may be adequate 
- PPI therapy more effective 
Stage 3: 
- PPI therapy x 1/2 daily

Question 7

What is anti-reflex surgery?

Answer 7

Wrap muscle around lower oesophagus to strengthen oesophageal sphincter

Question 8

What are the most common causes of gastric ulcers?

Answer 8

1. H. Pylori
2. NSAIDs
3. Carcinoma

Question 9

What is H.Pylori?

Answer 9

• faeco-oral
• infects stomach mucosa = gastritis, increased gastric secretion + gastric metaplasia = ulceration
• most asymptomatic

Question 10

What are the 2 patterns of H.Pylori infections?

Answer 10

1. Pangastritis
   atrophy parietal cells > reduced acid > GU
2. Antral gastritis
   increased gastrin > increased acid > gastric gastric metaplasia in duodenum > DU

Question 11

How is H.Pylori diagnosed?

Answer 11

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Urea breath test
Stool antigen 
Serology 
-

Question 12

How is H.Pylori treated?

Answer 12

3 drugs (PPI + 2 antibiotics)
2 x day
1 week

Question 13

How is GI bleeding treated?

Answer 13

Inject adrenaline > tamponade + vasoconstriction of any ruptured arteries > stops bleeding acutely

To stop bleeding chronically artery can be cauterised/clipped

Question 14

What is a gastrectomy?

Answer 14

Surgical removal of part/whole stomach

Question 15

What are some endoscopic treatments for DU’s ?

Answer 15

• balloon dilation - for oesophageal strictures in chronic reflux
• stents - palliative for oesophageal malignancy
• feeding tubes
• endoscopy - resect early stage tumours

Question 16

What is functional dyspepsia and how is it treated?

Answer 16

Bloating/belching
- 
PPI
Prokinetic 
Tricyclic 
Relaxation techniques 
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