Upper gi disease Flashcards
1
Q
What medication can be used to eliminate formed acid?
A
- Antacids e.g. Rennie
2
Q
What types of medications can be used to reduce acid secretion ? (2 points)
A
- H2 receptor blockers
- Proton pump inhibitors
3
Q
How do antacids work?
A
- They convert acid into salt by neutralising it with alkali
- The salt is then absorbed
4
Q
What is the name of the cells in the stomach that produce acid?
A
- Parietal cells
5
Q
What are the 3 triggers for acid production in the stomach?
A
- Acetylcholine
- Gastrin
- Histamine
- Unless you block all 3 of these you will get acid secretion
6
Q
How do H2 receptor antagonists reduce acid production?
A
- By preventing histamine activation of acid production
7
Q
Are H2 receptor antagonists beneficial in reducing acid production?
A
- Limited benefit as alternative pathways are still active:
- Acetylcholine & gastrin
8
Q
What is Cimetidine? (3 points)
A
- An original H2 blocker (not used so much nowadays)
- Has many drug interactions (bad)
- Not fully effective
9
Q
What is Ranitidine? (3 points)
A
- A H2 blocker
- Safer in clinical use than Cimetidine
- Licensed for over the counter sales
10
Q
What is more effective clinically: H2 blockers or proton pump inhibitors?
A
Proton pump inhibitors
11
Q
What are 3 examples of proton pump inhibitors?
A
- Omeprazol
- Lansoprazole
- Pantoprazole
12
Q
What are 3 examples of upper GI diseases?
A
- Oral diseases
- Oesophageal disease
- Gastric disease
13
Q
What are the 3 main oral diseases?
A
- Recurrent oral ulceration
- Lichen planus
- Orofacial Granulomatosis
14
Q
What is minor aphthae?
A
- A form of recurrent oral ulcers
- Driven by the immune system
15
Q
Where can you get minor aphthae?
A
- Anywhere in the gut
16
Q
How long do minor aphthae last for?
A
- Last for about 2 weeks then go away
17
Q
How big are major aphthae?
A
- More than 1cm in size
18
Q
How long do major aphthae take to heal?
A
- Can take more than 3 months to heal
19
Q
What are herpetiform aphthae?
A
- Mouth ulcers
- Hundreds of small ulcers around the mouth
20
Q
Where do you get herpetiform aphthae?
A
- Get on underside of tongue, lips etc
- Do not get on keratinised mucosa in the mouth
21
Q
What is orofacial granulomatosis? (2 points)
A
- Problem where you get blockage of the lymphatics
- Channels blocked up by granulomatous cells
22
Q
At what age can you get orofacial granulomatosis?
A
- Can get this at any age
23
Q
In orofacial granulomatosis you can get swelling of the tissues and cobble stoning. What is cobble stoning?
A
- Longitudinal and circumferential fissures and ulcers separate islands of mucosa
24
Q
What is an endoscopy?
A
- A procedure in which an instrument is introduced into the body to give a view of its internal parts
25
What are 3 examples of oesophageal disorders?
- Dysphasia
- Dysmotility disorders
- GORD
26
What is dysphasia?
- Problems swallowing
27
What happens in dysmotility disorders? (2 points)
- Fibrosis
| - Neuromuscular dysfunction (nerves and muscles don't work anymore)
28
What Is GORD?
- Gastro oesophageal reflux disease
29
What is a common reason for dysphasia? (2 points)
- Food getting stuck
| - Can be intermittent or constant
30
What are the different types of dysphasia? (3 points)
- Functional (anxiety, nervous system)
- dysmobility
- May be external compression
31
What is a more common name for GORD?
- Heartburn
32
What are the 3 main causes of GORD?
- Defective lower oesophageal sphincter
- Impaired lower clearing
- Impaired gastric emptying
33
What are 3 consequences of GORD?
- Ulceration
- Inflammation
- Metaplasia
34
What is metaplasia?
The change in the type of adult cells in a tissue to form abnormal cells for that tissue
35
What are common signs & symptoms of GORD? (4 points)
- Epigastric burning
- Dysphasia
- GI bleeding
- Severe pain (mimics MI)
36
Epigastric burning is a common symptom of GORD. What makes this worse? (3 points)
- Lying down
- Bending
- Pregnancy
37
Severe pain is a common symptom of GORD. What causes this?
- Oesophageal muscle spasm
38
In GORD, dysphasia can be caused by oesophagitis, stricture or dysmotility. What do these 3 terms mean?
Oesophagitis = inflammation of the oesophagus
Stricture = Abnormal narrowing of a canal in the body
Dysmotility = muscles not working as they should
39
What is Barrett's Oesophagus? (2 points)
- Recurrent acid reflux into the lower part of the oesophagus
- Metaplasia of the oesophageal lining to gastric type mucosa
40
What is Barrett's oesophagus associated with?
- Malignant change - adenocarcinoma
41
What is a hiatus hernia?
- Where part of the stomach is in the THORAX
42
What are the symptoms of a hiatus hernia similar to?
- Similar to GORD symptoms
43
Are hiatus hernias more common in men or women?
- Women
44
How can you manage GORD? (5 points)
- Stop smoking
- Lose weight & avoid triggering activity
- Antacids
- H2 blockers & PPI's (ranitidine & omeprazole)
- Increase GI motility & gastric emptying)
45
Why can stopping smoking manage GORD?
- It improves the sphincter
46
Where in the body does peptic ulcer disease affect? (3 points)
- Oesophagus, stomach, duodenum
| - ANY acid affected site
47
What are the causes of peptic ulcer disease? (3 points)
- High acid secretion (duodenal)
- Normal acid secretion (stomach)
- Drugs (NSAIDS, steroids)
48
Where can peptic ulcer disease occur if there is EXCESSIVE acid production? (2 points)
- Oesophageal ulcers
| - Duodenal ulcers
49
Why does peptic ulcer disease occur is there is a NORMAL acid production?
- Due to a reduced protective barrier
50
Which bacterium is involved in peptic ulcer disease when there is NORMAL acid production?
- Helicobacter pylori
51
How do helicobacter pylori cause peptic ulcer disease?
- They cause inflammation of the gastric mucosa so there is a loss of the mucous barrier
52
What effects can helicobacter pylori have? (2 points)
- Gastric ulcers
| - Chronic gastric wall inflammation (lymphoma of the stomach)
53
How can you eliminate helicobacter pylori? (2 points)
- TRIPLE THERAPY
| - 2 antibiotics and 1 proton pump inhibitor
54
What are the common signs and symptoms of peptic ulcer disease? (3 points)
- Asymptomatic
- Epigastric burning pain
- Usually NO physical signs (only when there are complications e.g. bleed)
55
A possible symptom of peptic ulcer disease is epigastric burning pain. When is this worse and how can it be relieved? (3 points)
- Worse before/just after meals
- Worse at night
- Relieved by food, alkali and vomiting
56
What investigations can be done for peptic ulcer disease? (4 points)
- Endoscopy
- Radiology (barium meal)
- Anaemia (FBC and faecal occult blood test
- H. pylori - breath, antibiotics, mucosa
57
What are local complications of peptic ulcer disease? (4 points)
- Perforation
- Haemorrhage
- Stricture
- Malignancy
58
What is a systemic complication of peptic ulcer disease?
- Anaemia
59
When can medical treatments of peptic ulcer disease be used? (3 points)
- Reversible problem
- Lifestyle changes
- H. pylori present
60
When can surgical treatments of peptic ulcer disease be used? (4 points)
- Stricture
- Acute bleed
- Perforation
- Malignancy
61
What are treatments of peptic ulcer disease? (9 points)
- Medical
- Stop smoking
- Small regular meals
- Eradication therapy
- Ulcer healing drugs (PPI)
- Surgical
- Endoscope
- Surgical repair (gastrectomy)
- Vagotomy
62
What is a vagotomy?
- A surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion
63
What medication is used in upper GI disease to reduce acid secretion? (2 points)
- H2 receptor blockers
| - Proton pump inhibitors
64
How can you improve the mucosal barrier in upper GI disease? (4 points)
Eliminate helicobacter
Inhibit prostaglandin removal:
- NSAID use encourages this - avoid
- Reduce steroid use
65
Triple therapy is used to eliminate helicobacter pylori. What antibiotic and PPI are used? (3 points)
Antibiotics:
- Amoxycillin
- Metronidazole
Proton pump inhibitor:
- Omeprazole
