106 - GORD/PUD

Question 1

What factors can cause GORD?

Answer 1

Decreased salivation
Delayed gastric emptying
Malfunction of oesophageal sphincter - immature, transient relaxation of decreased resting tone
Impaired oesophageal clearance

Question 2

What is barrett’s oesophagus?

Answer 2

Reprogramming of oesophageal stem cells, from ulcerated squamous epithelium (white) to columnar epithelium

• The metaplasia can be to columnar epithelium similar to the stomachs cardia - mucous glands present, body - parietal cells present, intestinal - goblet cells in mucous glands.

Question 3

What are the 3 types of dyspepsia?

Answer 3

Postprandial fullness
Early satiation
Epigastic pain

Question 4

What can cause gastritis?

Answer 4

Acute - chemical injuries

Chronic - Helicobacter pylori infection, NSAID chemical dmamade, autoimmune - pernicious aneamia

Question 5

What are the 2 types of H pylori infection extent - how does it effect acid production?

Answer 5

Pan gastritis - body and antrum - reduced acid production

Antral gastritis - increased acid production

Question 6

What is pernicious anaemia?

Answer 6

Antibodies against parietal cells - no intrinsic factor is made - so B12 cant be absorbed - so you get anaemia

Question 7

What causes Peptic Ulcer Disease?

Answer 7

Acid + pepsin - ulcerogenic

Question 8

What are the redflag signs in peptic ulcers?

Answer 8

Weight loss
Persistant vomiting
Progressive dysphagia
Haematemesis
Palpable mass
Jaundice

Question 9

What complications are possible with a peptic ulcer?

Answer 9

Perforation
Haemorrhage
Penetration to surrounding organs
Obstruction
Cancer

Question 10

How is blood supply distributed to the oesophagus?

Answer 10

upper 1/3: Inferior thyroid artery
Middle 1/3: Decending aortic branches
bottom 1/3: Left gastric artery branches

Question 11

What are the 4 types of treatment in GORD/PUD?

Answer 11

Antacids+alginates
Mucosal defence promotos - sucralfate, misoprostol
Gastric stimulants - domperidone, metoclopramide
Reduction of acid production - PPIs (omeprazole), H2 receptor antagonists (ranitidine)

Question 12

What do antacids do?

Answer 12

Neutralise acid - eg. sodium bicarb

Question 13

What do alginates do?

Answer 13

Reduce irritancy of acid - eg. simeticone

Question 14

What contraindication is there with misoprostol?

Answer 14

Women of childbearing age - induces abortion

Question 15

How do H2 receptor antagonists work?

Answer 15

Reversibly + competitively bind to H2 receptor, blocks it, supresses gastric secretion of acid

Question 16

Where are parietal cells in the stomach? What do they produce?

Answer 16

In body + fundus of stomach
HCL
Intrinsic factor

Question 17

Where are chief cells in the stomach? What do they produce?

Answer 17

In the body + fundus
Produce pepsinogen (converted to pepsin by HCL)

Question 18

Where are G cells? What do they produce?

Answer 18

In bottom of gastric glands - in antrum

Secrete gastrin (which stimulates parietal cells)
inhibited by somatostatin

Question 19

How is the parietal cell activated to produce acid?

Answer 19

By histamine (H2 receptor)
By Ach (M3 receptor
By Gastrin (CCK2 receptor

inhibited by prostaglandin receptor