Upper GI conditions and treatment Flashcards

1
Q

cause of gastritis

A

inflammation of gastric mucosa, 80% caused by H pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

risks with gastritis

A

40 x increase risk of PUD 6 x increased risk of gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of hiatus hernia

A

stomach pushed up through diaphragm prevents LOS closure and stomach contents escape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

causes of functional dyspepsia

A
  • Dyspepsia with no organic disease - Four groups ○ Ulcer like ○ Dysmotility like ○ Reflux like - ongoing heartburn and reflux (GORD considered but endoscopy showed no organic disease) ○ Non-specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

functional dyspepsia treatment

A
  • HP eradication - dietary changes - PPI/H2 and monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

causes of H Pylori

A
  • Bacteria able to survive in acidic environments that protects themselves by hydrolysing urea to produce ammonia between mucus layer in antrum * Chronic inflammation - decreases somatostatin * Increases gastrin + acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how is H Pylori tested for

A
  • Identified breath test or stool antigen test ○ Given radio labelled urea - broken down by H Pylori, so CO2 in breath will be radio labelled ○ Stool test (- 20 degrees before testing) § Avoid abx 4 weeks before!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

H Pylori risks

A

causes 90% of duodenal ulcers and 70-80% of stomach ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

treatment for H Pylori

A

7 day PPI and 2 x abx depending on local guidelines (amox & metronidazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

epidemiology of PUD

A
  • 10-15% of population - GU rare in <40s - DU in males 20-50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

factors causing PUD

A
  • gastric hypersecretion in DU- reduced mucosal resistance in GU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

risk factors for PUD

A
  • H pylori - NSAIDs - smokers - genetics - salt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

signs and symptoms of PUD

A

gastric - pain on eating duodenum - pain between meals relieved by eating - bloating - nausea - anorexia - belching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PUD treatment

A
  • eradicate HP - lifestyle/causative agent - H2 agonist/PPI for 4-8 weeks and retest - if recurrs - PPI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

drugs that cause dyspepsia

A

NSAIDSsulfasalazine iron corticosteroids potassium bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

causes of GORD

A

Defective lower oesophageal sphincter (LOS) may have an effect - diet - cigarettes - high oestrogen/progesterone - beta blockers, ccb, diazepam, contraceptivesMotility of oesophagus may be abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

drugs that cause ulceration

A
  • NSAIDs- bisphosphonate - clindamycin - clotrimazole - doxycycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

main symptom of GORD

A

heartburn, potentially dysphagia or odynophagia

19
Q

diagnosis of GORD

20
Q

complications of GORD

A

Barrett’s oesophagus - cell lining changes to resemble that of intestine

21
Q

treatment for GORD

A
  • remove causative agent - lifestyle changes - rafting product to promote healing
22
Q

lifestyle changes for GORD

A
  • small meals - avoid foods that lower LOS pressure - avoid fatty foods - reduce alcohol - reduce tight clothes - raise head of the bed
23
Q

no organic disease present

A

functional dyspepsia

24
Q

heartburn and pain immediately with or after food

25
Epigastric pain immediately with or after food
gastritis or gastric ulcer
26
Epigastric pain between meals or at night relieved by eating
gastritis or duodenal ulcer
27
how do antacids work
neutralise acid and increases LOS pressure by alkalisation - short term relief
28
side effects of antacids
aluminium - constipation magnesium - diarrhoea
29
interactions/ C/Is with antacids
enteric coated medicines reduced absorption of tetracyclines generally safe in pregnancy
30
how do alginates work
form a high pH viscoid mass to trap acid in stomach
31
how does dimethicone work
anti-foaming agent, reduces surface tension of intragastric air bubble - bubble escapes to reduce bloating
32
moa of h2 agonists
competes for h2 receptors on parietal cells
33
use of h2 agonists in pud
high healing rates but no relapse reduction
34
use of h2 agonists in GORD
* After 12 weeks, 80-90% of patients with mild oesophagitis improved * Not effective in moderate to severe GORD
35
side effects with h2 agonists
- headache and dizziness - cimetidine can cause gynaecomastia, impaired libido (CYP) - nizatidine can cause sweating, abnormal dreams and confusion
36
moa of ppis
blocks hydrogen potassium ATPase to prolong suppression of acid secretion
37
side effects of ppis
nausea, diarrhoea, flatulence, epigastric pain, dry mouth and headache and can cause rebound dose
38
OTC PPI
omeprazole - 10/20mg for >18 y/o
39
when to refer to gp with otc treatment
- 2 weeks with no relief - treatment required continuously for 4 weeks - over 45 with new symptoms
40
how is metoclopramide and domperidone used for GI disturbances
increases gastric emptying and LOS tone
41
how is sucralfate used for GI disturbances
Polymerizes below pH4 to form a sticky gel to form protective barrier over ulcer
42
how is bismuth used for GI disturbances
- binds to ulcer craters to protect them, may blacken teeth and stools
43
how is misoprostol used for GI disturbances
Promotes ulcer healing by stimulating protective mechanism - usually with NSAIDs