Treatment of peptic ulceration and inflammatory bowel disease

Question 1

Gastric secretions are needed for

Answer 1

Digestion of food

Iron absorption Killing pathogens

Question 2

role of mucous secreting cells

Answer 2

Trap bicarbonate ions (alkaline) Creates gel like barrier Important protective layer

Question 3

role of prostaglandins

Answer 3

Stimulates secretion of mucus and bicarbonate Dilate mucosal blood vessels
Cytoprotective

Question 4

what drugs disturb the protective layer

Answer 4

NSAIDs disturb these protective functions (inhibit cyclo-oxygenase-1; enzyme responsible for synthesis of prostaglandins) i.e. increase this risk

Question 5

Oxyntic / parietal cells

Answer 5

Hydrochloric acid (HCl) Intrinsic factor

Question 6

chief / peptic cells

Answer 6

Proenzymes e.g. prorennin and pepsinogen

Question 7

1. Gastrin

Answer 7

• Gastrin is a polypeptide hormone
• Gastrin is secreted by gastrin cells; G cells
• Located in the gastric antrum and duodenum
• Proteins in food have a strong effect on the gastrin
cells
• Gastrin is released into the blood
• Stimulates secretion of acid by parietal cells (through the
proton pump)
• Also increases pepsinogen secretion–stimulates
blood flow and increases gastric motility

Question 8

2. Acetylcholine

Answer 8

• Released from neurons
• Stimulates muscarinic receptors on surface of parietal
cells and histamine containing cells

Question 9

3. Histamine

Answer 9

• Mast cells lying close to parietal cell release histamine
• Histamine release increased by gastrin and
acetylcholine
• Acts on parietal cell H2 receptors

Question 10

outcome of chronic infection of h.poylri depends on

Answer 10

Pattern of inflammation Host response Bacterial virulence Environmental factors Patient age

Question 11

diagnosis of h.pylori

Answer 11

Non-invasive:
urea breath test 
stool antigen 
Biopsy based:
rapid urease test

Question 12

Investigations for Inflammatory Bowel Disease

Answer 12

 FBC, CRP
 StoolMCS
 Faecalcalprotectin
 CT scan/MRI
 Endoscopy (sigmoidoscopy, colonoscopy) + biopsies

Question 13

Complications of Inflammatory Bowel Disease

Answer 13

 Stoma
 Anaemia
 Perforation
 Obstruction/stricture
 Fistulae
 Toxicmegacolon
 Malnutrition
Increased risk of bowel cancer

Question 14

Inflammatory Bowel Disease

Answer 14

 Means Ulcerative Colitis or Crohn’s
 UC affects colon and rectum, inner lining; Crohn’s can
affect any part of GI tract, through whole wall