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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?

A

Endoscopy

24
Q

What is functional dyspepsia

A

AKA NonUlcerDisease
No obvious cause

25
Q

How to treat functional dyspepsia

A

Eradicate H. Pylori if present
Neutralise acid etc
Monitor

26
Q

How to manage stomach and duodenal ulcers?

A

Eradicate H. Pylori
Stop inappropriate therapy
Decrease acid to decrease gastritis and allow mucosa repair
-> Block H2 or proton pump

27
Q

How to manage GORD?

A

Remove anything that decreases LOS pressure
Non pharmalogical advice
Rafting products- gaviscon
reduce acid production to enable recovery of oesophageal mucosa

28
Q

What are some none pharmaceutical managements for GORD

A

Eat small meals
avoid fatty foods
Avoid eating within 4hrs of bed
Avoid tight clothing and lose weight
Raise head when eating

29
Q

What are some managements for dyspepsia?

A

Neutralise acid
Reduce flatulence
Treatments OTC

30
Q

What are antacids

A

neutralise acids
Eructation (burping)
Increases LOS pressure -> stimulates prostaglandin synthesis
Relief of heart burn and indigestion
Avoid long term - helps symptoms

eg: rennie

31
Q

What are some side effects of Antacids

A

Al- constipation
Mg- diarrhoea
Avoid sodium when Pt has HT or cardiac problems

32
Q

How do alginates work

A

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
Q

How does dimethicone work

A

(simeticone)
Anti-foaming agent
Decrease surface tension of intragastric air bubble
Allows bubbles to escape - decrease bloating feeling

34
Q

How do H2 receptor antagonists work

A

cimetidine etc
Compete for H2 receptor on parietal cells (if eat a big meal the overridden)
Helps PUD and mild oesophagitis GORD

35
Q

What is the cause of the interactions with cimetidine

A

it binds to P450!
so interactions w phenytoin, theophylline, warfarin etc

36
Q

name a H2 antagonist

A

Ranitidine
relieves heartburn, dyspepsia and hyperacidity

37
Q

How long can H2 antagonists be used for OTC

A

6 days MAX

38
Q

How do PPI (proton pump inhibitors) work

A

Omeprazole, lansoprazole etc
Blocks hydrogen- potassium ATPase enzymes
Prolonged suppression of acid secretion

39
Q

Why PPI over H2 antagonists?

A

Heals ulcers more rapidly than H2 antagonists

40
Q

Side effects of PPI’s?

A

Short term- nausea diarrhoea flatulence epigastric pain dry mouth headache
joint pain and muscle ache

41
Q

When should someone take lansoprazole

A

Before food- food decreases bioavailability

42
Q

What needs to be know about PPI use OTC -dose, duration, referral

A

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
Q

Other drugs that help upper GI issues

A

metoclopramide and domperidone
Sucralfate
Bismuth
Misoprostol

44
Q

What treatments are used for functional and dyspepsia, gastritis or PUD?

A

remove causative agents
Dietary changes
Symptomatic agents
H2 antagonists or PPI’s

45
Q

What treatments are used for GORD?

A

Lifestyle and dietary changes
use alginates or PPI’s
(NOT H2 ANTAGONISTS)

46
Q
A

Yr 3 Inflammatory and GI (15 decks)

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