Upper Gastrointestinal

Question 1

How do NSAIDs lead to mucosal damage?

Answer 1

increased neutrophil adherence

damage from neutrophil derived free radicals & proteases

Question 2

What do G cells secrete?

Answer 2

gastrin

Question 3

What does gastrin stimulate? How?

Answer 3

enterochromaffin-like cells

action at gastrin/cholecystokinin2 receptors

Question 4

What receptor is found on parietal cells?

Answer 4

gastrin receptors

Question 5

What do enterochromaffin-like cells release? What is this enhanced by?

Answer 5

histamine

enhanced by gastrin and acetylcholine

Question 6

What does Somatostatin inhibit?

Answer 6

release of gastrin
histamine
acid from parietal cells

Question 7

How do Prostaglandins protect gastric mucosa?

Answer 7

increasing bicarbonate secretion
increase protective mucus production
reduce gastric acid secretion

Question 8

Tests to detect presence of Helicobacter pylori

Answer 8

carbon-13 urea breath test
stool antigen test
lab-based serology test

Question 9

How to treat functional dyspepsia if H.pylori is not present

Answer 9

4 week-course of proton pump inhibitor

or H2 blocker

Question 10

H.pylori mechanism of action

Answer 10

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

Question 11

What do D cells release?

Answer 11

Somatostatin

Question 12

First line treatment for H.pylori

Answer 12

7 day, twice daily
PPI
amoxicillin, clarithromycin/metronidazole

Question 13

Second line treatment for H.pylori

Answer 13

out of clarithromycin/metronidazole

whichever wasn’t used first

Question 14

Treatment for gastro-oesophageal reflux disease

Answer 14

full dose of PPI for 4 or 8 weeks

Question 15

Treatment for GORD, if inadequate response to PPI?

Answer 15

offer H2 receptor Antagonist

Question 16

Treatment for GORD, if oesophageal stricture present?

Answer 16

long-term, full-dose PPI treatment

Question 17

Examples of Proton-pump inhibitors

Answer 17

omeprazole

lansoprazole

Question 18

Where do Proton-Pump Inhibitors concentrate?

Answer 18

canaliculi of parietal cells

Question 19

What do Proton-Pump Inhibitors target?

Answer 19

H+/K+ ATPase pump

Question 20

The active form of omeprazole

Answer 20

sulfanemide form

Question 21

Suffix of PPIs

Answer 21

’‘-prazole’’

Question 22

Clinical uses of PPIs (5)

Answer 22

gastric and duodenal ulcer
hypersecretory states
GORD
NSAID associated ulcer
dyspepsia relief

Question 23

H2 receptor analogue examples

Answer 23

Ranitidine
Famotidine
Cimetidine

Question 24

H2 receptor analogue suffix

Answer 24

’‘-tidine’’

Question 25

H2 receptor analogue mechanism of action

Answer 25

competitive antagonists | reduced action of histamine in acid production

Question 26

Antacid examples

Answer 26

Sodium bicarbonate salts Magnesium hydroxide Magnesium carbonate Aluminium hydroxide gel

Question 27

Antacid mechanism of action

Answer 27

weak bases quickly neutralise hyperacidity of stomach in dyspepsia short term

Question 28

Bismuth Salts mechanism of action

Answer 28

toxic to H.pylori interfere with adherence to gastric mucosa treatment of mild dyspepsia

Question 29

What is Sucralfate made up of?

Answer 29

aluminium hydroxide | sulfated sucrose

Question 30

Sucralfate mechanism of action

Answer 30

provides protective coating on the mucus