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Yr 3 Inflammatory and GI > Upper GI > Flashcards

Upper GI Flashcards

1
Q

What do chief cells secrete

A

Pepsinogen

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2
Q

What do parietal cells secrete

A

HCl and intrinsic factor

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3
Q

How is acid secretion from parietal cells controlled?

A

Nervous control- cephalic phase (thought, smell, taste of food)
Local control- gastric phase (distension of stomach)
Hormonal control- intestinal phase (food in duodenum-> somatostatin which inhibits acid production)

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4
Q

What stimulates secretion of H+ from parietal cells

A

Histamine, gastrin and acetylcholine

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5
Q

What does the parietal cell do to produce H+?

A

Proton pump -> exchanges H+ with K+ in gastric lumen

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6
Q

What is the parietal cell stimulated by?

A

Vagus nerve- acetylcholine (M3 receptor)
Gastrin (G receptor)
Histamine (H2 receptor)
Somatostatin -ve feedback doe to contents in duodenum

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7
Q

What is gastric cytoprotection?

A

Prevents digestion of stomach
Thin layer above mucosa surface
H+ taken away by sub-mucosal blood flow
Decreased blood flow = incr. H+ conc -> necrosis

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8
Q

What is somatostatin

A

Prostaglandin! incr. mucus, incr. bicarbonate, incr. blood flow, decr. acid.
Therefore NSAIDs may interfere with the negative feedback process

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9
Q

What is gastritis?

A

Inflammation of stomach lining

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10
Q

What may cause gastritis?

A

Inflammatory response of GI mucosa to H. Pylori -> leads to Gastric cancer

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11
Q

Why is H. Pylori bad?

A

Colonises beneath mucus layer-> ammonia production and inflammation -> decreases Somatostatin -> increases gastrin production -> increases acid production
(colonises -> inflammation -> decr. somatostatin - incr. gastrin -> incr. acid)

incr. acid = inflammation in duodenum = reduces local protection = Ulcers!

Damaged cells = less mucosa and less acid causing gastric ulcers and cancers

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12
Q

What is PUD?

A

Peptic Ulcer Disease
Gastric ulcers

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13
Q

What is a major cause of PUD

A

H. Pylori
NSAIDs
Smoking

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14
Q

What drugs may cause dyspepsia

A

NSAIDs
Sulfasalazine
Iron preps
Corticosteroids
Potassium
Bisphosphonates
Nitrates
Calcium antagonists
Theophylline

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15
Q

What are signs and symptoms of PUD

A

Gastric- Pain on eating (and epigastric pain)
Duodenal- localised pain between meals and at night, relief by eating

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16
Q

Summary- what causes gastric stomach ulcers

A

Prolonged exposure to H. Pylori
NSAIDs

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17
Q

Summary- what causes duodenal ulcers

A

Excessive acid secretion from stomach due to H. Pylori

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18
Q

What is GORD?

A

Upper GI condition
Symptomatic reflux caused by gastric juice
Can be from defective Lower oesophageal sphincter

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19
Q

What can lower the pressure of the lower oesophageal sphincter?

A

Diet- fat, chocolate, caffeine, alcohol
Smoking
High oestrogen
Drugs

20
Q

What is a hiatus Hernia

A

Stomach pushed through diaphragm
Prevents LOS from closing and allowing stomach contents to escape

21
Q

What drugs may cause a lower Lower oesophageal sphincter pressure?

A

Beta- 2 antagonists
CCBs
Diazepam
Alcohol
Oral contraceptives
Anticholinergics

22
Q

What drug class usually causes oesophageal ulceration

A

Antibiotics!

23
Q

How is GORD diagnosed?

24
Q

What is functional dyspepsia

A

AKA NonUlcerDisease
No obvious cause

25
How to treat functional dyspepsia
Eradicate H. Pylori if present Neutralise acid etc Monitor
26
How to manage stomach and duodenal ulcers?
Eradicate H. Pylori Stop inappropriate therapy Decrease acid to decrease gastritis and allow mucosa repair -> Block H2 or proton pump
27
How to manage GORD?
Remove anything that decreases LOS pressure Non pharmalogical advice Rafting products- gaviscon reduce acid production to enable recovery of oesophageal mucosa
28
What are some none pharmaceutical managements for GORD
Eat small meals avoid fatty foods Avoid eating within 4hrs of bed Avoid tight clothing and lose weight Raise head when eating
29
What are some managements for dyspepsia?
Neutralise acid Reduce flatulence Treatments OTC
30
What are antacids
neutralise acids Eructation (burping) Increases LOS pressure -> stimulates prostaglandin synthesis Relief of heart burn and indigestion Avoid long term - helps symptoms eg: rennie
31
What are some side effects of Antacids
Al- constipation Mg- diarrhoea Avoid sodium when Pt has HT or cardiac problems
32
How do alginates work
forms a high pH viscid mass (raft) traps air and bubbles and CO2 from antacid with the stomach contents Floats to top of stomach and protects oesophageal mucosa from stomach contents
33
How does dimethicone work
(simeticone) Anti-foaming agent Decrease surface tension of intragastric air bubble Allows bubbles to escape - decrease bloating feeling
34
How do H2 receptor antagonists work
cimetidine etc Compete for H2 receptor on parietal cells (if eat a big meal the overridden) Helps PUD and mild oesophagitis GORD
35
What is the cause of the interactions with cimetidine
it binds to P450! so interactions w phenytoin, theophylline, warfarin etc
36
name a H2 antagonist
Ranitidine relieves heartburn, dyspepsia and hyperacidity
37
How long can H2 antagonists be used for OTC
6 days MAX
38
How do PPI (proton pump inhibitors) work
Omeprazole, lansoprazole etc Blocks hydrogen- potassium ATPase enzymes Prolonged suppression of acid secretion
39
Why PPI over H2 antagonists?
Heals ulcers more rapidly than H2 antagonists
40
Side effects of PPI's?
Short term- nausea diarrhoea flatulence epigastric pain dry mouth headache joint pain and muscle ache
41
When should someone take lansoprazole
Before food- food decreases bioavailability
42
What needs to be know about PPI use OTC -dose, duration, referral
dose - omeprazole 20mg a day until symptoms better then 10mg Swallow whole w liquids Refer if after 2 weeks, no relief Refer if treatment req. for 4 weeks continuously Refer if over 45yrs and present with new or changed symptoms
43
Other drugs that help upper GI issues
metoclopramide and domperidone Sucralfate Bismuth Misoprostol
44
What treatments are used for functional and dyspepsia, gastritis or PUD?
remove causative agents Dietary changes Symptomatic agents H2 antagonists or PPI's
45
What treatments are used for GORD?
Lifestyle and dietary changes use alginates or PPI's (NOT H2 ANTAGONISTS)
46

Yr 3 Inflammatory and GI (15 decks)

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