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Year 3 > Week 4 - upper GI GORD/FD/ Gastritis / Gastric ulcer > Flashcards

Week 4 - upper GI GORD/FD/ Gastritis / Gastric ulcer Flashcards

1
Q

What are the main symptoms of GORD

A

Heart burn - ( pain during or right after food)

Dysphagia

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2
Q

What is GORD caused by?

A

Gastric juice in the oesphagus

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3
Q

What physiological factors can affect GORD?

A

A Defective Lower oesphageal Sphincter can allow stomach acid up

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4
Q

What drugs affect a LOS?

A
  • Anti-cholinergic
    -Nitrates
    CCB
    B2 antagonist
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5
Q

Name the drugs that can cause oesphageal ulcers?

A
  • Doxycline
    NSAID
  • potassium
    biphosphates
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6
Q

What is the difference between Functional dyspepsia and GORD?

A

GORD can be diagnosed with an endoscopy and is an organic disease

Functional dyspepsia is th epresence of chronic dypepsia and sensitivity to gastric acid / heartburn with no organic disease

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7
Q

Describe the symptoms for Gastritis / Gastric ulcer

A

Epigastric pain - ( pain between meals can be relieved with food

or pain can be w or immediatly after food

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8
Q

Describe symptoms of Gastritis / duodenum ulcer

A

Epigastric pain BUT pain between meals or at night and is relieved by food

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9
Q

Describe the management and treatment for stomach/ Duodenum ulcer

A
  • Test and eradicate HP ( H pylori)
  • aim to reduce gatric acid production to reduce gastritis
  • H2 antagonists provided or PPI
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10
Q

Describe the non-pharmacuetical management of GORD

A

Lifestyle advice:

  • LEss fatty + spicy + acidic foods
  • avoid drugs lowering LOS pressure
  • avoid eating twithin 2 hrs of bed
  • reduce alcohol
  • stop smoking
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11
Q

What is gastric cytoprotection?

A

The prevention of suto-digestion by a thing layer of mucus and bicarbonate ( ph 7) on the mucosa surface

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12
Q

How do NSAIDs affect gastric cytoprotection?

A

They affect prostaglandin ( somatostatin ) synthesis

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13
Q

Name and Describe how prostaglandins aid in gastric cytoprotection

A

Somatostatin a Prostaglandin increases mucus secretion —> increases bicabonate—> increases blood flow ——> decreases acid production

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14
Q

Describe how gastritis leads to ulceralation

A

H . pylori triggers inflammatory repose from GI mucosa leads to chronic gastritis —-> PUD—–> Gastric cancer

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15
Q

Describe where H pylori colonises and how it affects the GI tract

A

In the antrum and can cause chronic inflammation by triggering an inflammatory response as well as decrease somatostatin synthesis meaning increased gastrin and increased acid

Increased stomach acid means increased inflammation in duodenum leading to D ulcers

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16
Q

How can H pylori be tested for?

A
  • Breath test against radioactive urea
  • Stool antigen test
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17
Q

What are the two types of ulcers in PUD and how do they differ?

A

Duodenum ulcer - higher levels of acid output

Gastric Ulcer- less mucosal resistance can be caused by smoking

18
Q

What risk factors are associated with PUD ?

A
  • Smoking decreases mucus layer increased likelyhood of acid auto digestion irritation
19
Q

What drugs induce dyspepsia ?

A
  • NSAIDS
  • Bisphophates
  • Nitrates
  • sulfasalazine
20
Q

Describe the symptoms of PUD

A
  • EPigastric pain
  • Localised pain at night or between meals
    bloated/nausea
21
Q

Describe drugs that induce dyspepsia

A
  • NSAIDS risk increased in elderly, smokers
  • Sulfasalazine
    corticosteroids bisphosphonates
  • nitrates
22
Q

Why do NSAIDS induce dyspepsia ?

A
  • NSAiDs inhibit protsglandin production via COX 1 pathway which is the pathway for GI protective prostaglandins ( non- selective NSAIDs affect COX 1 pathway more than COX 2 selective )

( flow of COX1 inhibiton consequences) - synthesis such as somatostatin which usually in hibits gastrin production as gastrin increases this is ligand for parietal cell for HCL produced . dudodenum inflammation

23
Q

What are antacids and how do they work?

A

Are basic salts ( inc magnesium, calcium salts ) which neutralise stomach acid

MOA- Increase prostaglandin synthesis and increase LOS pressure by neutralization on gastric acid

24
Q

Which form of antacids are faster acting and what are th counselling points for antacids ?

A
  • liquid form faster acting ( short acting)
  • heartburn / indigestion relief
  • ONLY is SHORT TERM relief
  • AVOIDED IN HYPERTENSION/CVD patient — increased sodium —–> increased BP
25
Q

What are the side effects of antacids?

A
  • Constipation
  • diarrhoea
  • neurotoxicity ( absorption of aluminium salt)
  • Osteoporosis - aluminium binding to gut
  • Rebound gastric acid
    -potentially increased bp should not be used in hypertensive patients
26
Q

What are Alginates and how do they work?

A
  • formed using a alginates
  • form a layer over stomach acid
  • intragastric air bubble and CO2 from antacid trapped in prevent mucosal damage
27
Q

What is Dimeticone and how does it work ?

A
  • Anti-foaming agent
  • reduces bloating by releasing trapped intragastric air bubbles
28
Q

What are H2 receptor antagonists?

A
  • Competitive inhibitor for H2 receptor on parietal cells
29
Q

What are examples of H2 antagonists and what are their indications?

A
  • Cimetidine
  • famotidine
  • ranitidine
  • nizatidine

PUD
Mild GORD

30
Q

What are the side effects of H2 antagonists?

A
  • headache
  • dizziness

Cimetidine - Gynaecomastia
Nizatidine - sweating

31
Q

What drug interaction are there with H2 antagonists?

A

Cimetidine - Theophylline & warfarin

32
Q

Name an example of OTC H2 antagonists

A
  • Ranitidine
  • relieves heartburn dyspepsia
33
Q

What Proton Pump Inhibitors and how do they work ?

A
  • Suppress acid secretion by Blocking H-potassium ATPAse enzyme

coated preparation is digested in small intestine

34
Q

Name some Proton pump inhibitors

A
  • omeprazole
  • lansoprazole
  • esomeprazole
35
Q

What is the first line treatment of GORD and why ?

A

PPIs are used as first line treatment in GORD over H2 antagonists as they also heal ulcers faster than H2 antagonists

36
Q

What are the side effects of PPIs?

A
  • nausea
  • diarrhoea
  • epigastric pain
  • increase risk of bacterial infection due to overgrowth ( H pylori / salmonella)
37
Q

What are some OTC PPIs? And when would a referral be made

A

Omeprazole 10/20mg
- reflux symptoms

20mg daily until symptoms improve then 20mg

  • 2 weeks use and still no improvement
  • Patient over 45 with new or changed symptom
38
Q

What treatment is given in the presence of Functional dyspepsia, Gastritis or PUD ?

A

Functional Dyspepsia / Gastritis / PUD-

  • PPIs and H2 antagonists
  • Removal of cause so dietary changes
39
Q

Which treatment is given to patients with GORD?

A
  • NOT H2 ANTAGONISTS!!
  • PPIs prolong acid secretion
40
Q

When would a patient need to be referred?

A
  • Continual of symptoms
  • Patient over 45 with new or changed symptom
  • weight loss loss of appetite
  • dysphagia
  • blood in vomit or stool

Year 3 (21 decks)

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