Upper Gastrointestinal Flashcards
How do NSAIDs lead to mucosal damage?
increased neutrophil adherence
damage from neutrophil derived free radicals & proteases
What do G cells secrete?
gastrin
What does gastrin stimulate? How?
enterochromaffin-like cells
action at gastrin/cholecystokinin2 receptors
What receptor is found on parietal cells?
gastrin receptors
What do enterochromaffin-like cells release? What is this enhanced by?
histamine
enhanced by gastrin and acetylcholine
What does Somatostatin inhibit?
release of gastrin
histamine
acid from parietal cells
How do Prostaglandins protect gastric mucosa?
increasing bicarbonate secretion
increase protective mucus production
reduce gastric acid secretion
Tests to detect presence of Helicobacter pylori
carbon-13 urea breath test
stool antigen test
lab-based serology test
How to treat functional dyspepsia if H.pylori is not present
4 week-course of proton pump inhibitor
or H2 blocker
H.pylori mechanism of action
produces urease, releases ammonium chloride
increase pH stimulates G cells
inflammatory mediators inhibit D cells
G cells increase release of gastrin
increased acid secretion, increased risk of ulcer formation
What do D cells release?
Somatostatin
First line treatment for H.pylori
7 day, twice daily
PPI
amoxicillin, clarithromycin/metronidazole
Second line treatment for H.pylori
out of clarithromycin/metronidazole
whichever wasn’t used first
Treatment for gastro-oesophageal reflux disease
full dose of PPI for 4 or 8 weeks
Treatment for GORD, if inadequate response to PPI?
offer H2 receptor Antagonist