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322 > Lecture 2: Management of Peptic Ulcer Disease and Gastro-Oesophageal Reflux Disease > Flashcards

Lecture 2: Management of Peptic Ulcer Disease and Gastro-Oesophageal Reflux Disease Flashcards

1
Q

What is dyspepsia?

A

A range of symptoms arising from the GI tract which are present for 4 weeks or more. These include upper abdominal pain, discomfort, heartburn, gastric reflux, nausea or vomiting

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2
Q

What is non ulcer dyspepsia?

A

There is no known cause for the symptoms. So other causes for the dyspepsia such as duodenal ulcers, stomach ulcers, inflamed oesophagus, inflamed stomach are not the cuase

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3
Q

What is a peptic ulcer?

A

Sores that develop in the lining of the stomach, lower oesophagis or small intestine

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4
Q

Are duodenal or gastric ulcers more common?

A

Duodenal

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5
Q

What causes bleeding in the GI lumen?

A

Damage to the blood vessels in the tissues underlying the ulcer may cause bleeding

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6
Q

What is the first sign of perforation?

A

Sudden, intense, steady abdominal pain

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7
Q

What is peritonitis?

A

When bacteria that live in your stomach escape and infect the lining of your abdomen. The infection can rapidly spread into the blood (sepsis)

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8
Q

What are the factors that protect the walls of the stomach from bieng digested?

A
  1. The surface of the mucosa is lined with cells that secrete a slightly alkaline mucus that forms a thin layer over the liminal surface. Both the protein content of mucus and its alkalinity neutralise hydrogen ions. The mucus forms a chemical barrier between the highly acidic contents of the lumen and the cell surface.
  2. Tight junctions between the epithelial cells lining of the stomach limit the diffusion of hydrogen into the underlying tissues
  3. Damaged epithelial cells are replaced every few days by new cells arising by the division of cells within gastric pits
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9
Q

How are ulcers formed?

A

Involved breaking down the mucosal barrier and exposing the underlying tissue to the corrosive action of acid and pepsin

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10
Q

Where can peptic ulceration occur?

A

Stomach or duodenum

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11
Q

What are characteristic features of peptic ulcers?

A
  • Epigastric pain
  • nocturnal pain
  • Vomiting
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12
Q

How is epigastric pain relived?

A

Antacids

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13
Q

Who are peptic ulcers common in?

A
  • Males
  • Smokers
  • Family history of the disease
  • People who use NSAIDs
  • Heavy alcohol intake
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14
Q

What type of peptic ulcers are more common in woman?

A

Gastric

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15
Q

What do ulcers require the presence of to occur?

A

acid and peptic activity

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16
Q

What are gastric ulcers associated with?

A

The breakdown of the protective function of the gastric mucosa and normal or redcued acid secretion

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17
Q

What are duodenal ulcers assosiacted with?

A

Excess acid secretion

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18
Q

What are the causes of peptic ulcers?

A
  • H pylori
  • NSAIDs
  • Pepsin
  • Smoking
  • Alcohol
  • Bile acids
  • Steroids
  • Stress
  • Changed in gastric mucin consistency
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19
Q

What are the defence mechanisms of peptic ulcers?

A
  • Mucus
  • Bicarbonate
  • Mucosal blood flow
  • Prostaglandins
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20
Q

What are aggressive factors of peptic ulcers?

A
  • NSAIDs
  • H pylori infection
  • Alchohol
  • Bile salts
  • Acid
  • Pepsin
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21
Q

What is the function of prostaglandin E?

A

Have an important protective role, PGE increases the production of both bicarbonate and the mucous layer

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22
Q

What are the two most important factors disrupting the balance between acid/pepsin attack and mucosal resistance?

A

H. pylori and NSAIDs.

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23
Q

How does H pylori lead to increased acid secretion?

A

Stimulates increased gastrin release and causes direct damage to the mucosa so disrupts the physiological balance

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24
Q

How do NSAIDs disrupt the balance between acid and mucosal resistance?

A

Impair mucosal resistance but dont alter acid secretion

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25
Q

How does smoking lead to peptic ulcers?

A

It is harmful to the gastroduoddenal mucosa, H pylori infiltration is denser in the gastric antrum of smokers. Smoking may increase susceptinility, deminisb the gastric mucosal defecensive factors or may provide a more favourable milieu for H pylori infection

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26
Q

How does ethanol lead to peptic ulcers?

A

Causes gastric mucosal irritation and nonspecific gastritis

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27
Q

What are the symptoms of peptic ulcers?

A
  • Abdominal discomfort
  • Pain that is burning or gnawing
  • Nausea
28
Q

How does eating affect gastric ulcers?

A

Pain is aggreaavted by eating

29
Q

How does eating affect duodenal ulcers?

A

Pain is releived by eating

30
Q

What is the most common symptom of gastric and duodenal ulcers?

A

Epigastric pain

31
Q

How is epigastric pain characterized?

A

Gnawing ot burning sensation that occurs after meals.

32
Q

What are the alarm features of peptic ulcer disease?

A

Bleeding, anemia, early satiety, unexplained weight loss, progressive dysphagia or odynophagia, recurrent vomiting, and family history of GI cancer

33
Q

What do patients with a perforated ulcer present with?

A

a sudden onset of severe, sharp abdominal pain

34
Q

When is an endoscopy required in the diagnosis of an ulcer?

A

When the patient is presenting for the first time, they are older than 55 and there is warning signs such as Iron-deficiency anaemia, chronic blood loss, weight loss, progressive dysphagia, persistent vomiting and an epigastric mass.

35
Q

What is an endoscope?

A

An endoscope is a device used to diagnose gastric or duodenal ulcers. It uses fibre optic technology to directly visualise the gastric and duodenal mucosa. The endoscopist can also apply local treatments and take samples of the tissue during the procedure

36
Q

What size are ulcers?

A

Usually range between 3mm and several cm in diamterer

37
Q

What part of the stomach does H pylori infect?

A

Lower part, antrum

38
Q

What does H pylori cause in the gastric mucosa?

A

Gastritis - inflammation of the gastric mucosa. This is often asymptomatic

39
Q

What enables H pylori to colonize in the stomach?

A

Has a high actvity of the enzyme urease

40
Q

How does H pylori avoid the acidic environment of the interior of the stomach?

A

H pylori uses its flagella to burrow into the mucus lining of the stomach to reach the epithelial cells underneath, where the pH is more neutral

41
Q

What is the most common test for diagnosing H pylori infections?

A

Serologic evaluation

42
Q

What diagnostic testing is used for H pylori infection diagnosis?

A
  • Urea breath test: based on the ability of H. pylori to break down urea, a chemical made up of nitrogen and carbon, into carbon dioxide which then is absorbed from the stomach and eliminated in the breath.
  • Stool antigen test: detects H pylori in the feaces.
43
Q

What drugs are used to treat peptic ulcer disease?

A
  • Antacids
  • Antisecretory agents: inhibit gastric acid secretion
44
Q

How long does rapid healing require?

A

min 18-20 hours if suppression per day

45
Q

Name histamine receptor antagonists

A
  • Cimetidine
  • Ranitidine
  • Nizatidine
  • Famotidine
46
Q

When does highest acid secretion occur?

A

Night

47
Q

What is the main stimulant for incraesed acid secretion?

A

Gastrin

48
Q

What are the adverse effects of H2 antagonists?

A
  • Diarrhoea
  • Headache
  • Confusion in elderly
  • Gynaecomastia with cimetidine
49
Q

What may cimetidine interact with?

A
  • Warfarin
  • Phenytoin
  • THeophyline
50
Q

Name proton pump inhibitors

A
  • omeprazole
  • lansoprazole
  • pantoprazole
  • rebaprezole
  • esomeprazole
51
Q

What are adverse effects of PPIs?

A

Gastrointestinal upset (e.g. epigastric discomfort, nausea and vomiting, diarrhoea)
Headache
Skin rashes
Omeprazole has both stimulatory and inhibitory effects on cytochrome P450 system
Long-term use may cause gastric atrophy

52
Q

What is the treatment for the eradication of H pylori infections?

A

Triple therapy: PPI, amoxicillan, clarithromycin or metronidazole for seven days, twice a day

For penicillin allergy: PPI, clarithromycin, metronidazole

52
Q

What is the treatment for the eradication of H pylori infections?

A

Triple therapy: PPI, amoxicillan, clarithromycin or metronidazole for seven days, twice a day

For penicillin allergy: PPI, clarithromycin, metronidazole

53
Q

Name cytoprotective agents

A

Misoprostol

54
Q

What is misoprostol?

A

A synthetic prostaglandin E analogue.

55
Q

What is the effect of misoprostol?

A

Has an ingibitory effect on acid secretion and also enhances the secretion of bicarbonate thus providing some additional protective properties. Can also be used to heal ulcers. is more commonly used prophylactically to prevent NSAID induced ulceration.

56
Q

Can misoprostol be used in pregnancy?

A

no as it will indice abortion

57
Q

What is zollinger ellison syndrom?

A

Zollinger-Ellison syndrome (ZES) is a rare disorder that can cause gastric or duodenal ulcers (usually multiple) and which also develop in unusual sections of the gastrointestinal tract, such as the jejunum.

58
Q

What causes zollinger ellison syndrome?

A

It is causes by a non–beta islet cell, gastrin-secreting tumour of the pancreas, or the upper part of your small intestine (duodenum) that stimulates the acid-secreting cells of the stomach to maximal activity,

59
Q

What is Gastro-oesophageal reflux disease (GORD) ?

A

The amount of acid secretion is normal, but the lower oesophageal sphincter doesnt function properly. It opens at times it shouldnt and allows excesive resflux of gastric content, acid and pepsin and bile into the oesophagus.

60
Q

What drugs are used to treat GORD?

A
  • Antacids and antacid/alginate combinations
  • Drugs that inhibit gastric acid secretion: H2 receptor antagonist and PPI
  • Drugs that act on oesophageal/ gastric motility
61
Q

What is the purpose of combining an alginate with an antacid?

A

The alginate provides an additional protective coating to the lower oesophagus, reducing mucosal contact with the refluxed contents.

62
Q

When are H2 antagonists effective in GORD?

A

When given in high doses

63
Q

What is the treatment for severe, difficult to control GERD symptoms?

A

Surgery using camera guided instruments - called a laparoscopic surgery.
Or a proceducre called Nissen fundoplication - excess stomach tissue is folded around the oesophagus and sewn in place. This holds extra pressure around the weakened oesophageal sphincter.

64
Q

What is barretts oesophagus?

A

Refers to an abnormal change in the cells of the lower portion of the oesophagus

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