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BDS2 BAMS > Upper gi disease > Flashcards

Upper gi disease Flashcards

1
Q

What medication can be used to eliminate formed acid?

A
  • Antacids e.g. Rennie
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2
Q

What types of medications can be used to reduce acid secretion ? (2 points)

A
  • H2 receptor blockers

- Proton pump inhibitors

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3
Q

How do antacids work?

A
  • They convert acid into salt by neutralising it with alkali
  • The salt is then absorbed
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4
Q

What is the name of the cells in the stomach that produce acid?

A
  • Parietal cells
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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
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6
Q

How do H2 receptor antagonists reduce acid production?

A
  • By preventing histamine activation of acid production
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7
Q

Are H2 receptor antagonists beneficial in reducing acid production?

A
  • Limited benefit as alternative pathways are still active:

- Acetylcholine & gastrin

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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
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9
Q

What is Ranitidine? (3 points)

A
  • A H2 blocker
  • Safer in clinical use than Cimetidine
  • Licensed for over the counter sales
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10
Q

What is more effective clinically: H2 blockers or proton pump inhibitors?

A

Proton pump inhibitors

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11
Q

What are 3 examples of proton pump inhibitors?

A
  • Omeprazol
  • Lansoprazole
  • Pantoprazole
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12
Q

What are 3 examples of upper GI diseases?

A
  • Oral diseases
  • Oesophageal disease
  • Gastric disease
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13
Q

What are the 3 main oral diseases?

A
  • Recurrent oral ulceration
  • Lichen planus
  • Orofacial Granulomatosis
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14
Q

What is minor aphthae?

A
  • A form of recurrent oral ulcers

- Driven by the immune system

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15
Q

Where can you get minor aphthae?

A
  • Anywhere in the gut
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16
Q

How long do minor aphthae last for?

A
  • Last for about 2 weeks then go away
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17
Q

How big are major aphthae?

A
  • More than 1cm in size
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18
Q

How long do major aphthae take to heal?

A
  • Can take more than 3 months to heal
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19
Q

What are herpetiform aphthae?

A
  • Mouth ulcers

- Hundreds of small ulcers around the mouth

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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

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21
Q

What is orofacial granulomatosis? (2 points)

A
  • Problem where you get blockage of the lymphatics

- Channels blocked up by granulomatous cells

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22
Q

At what age can you get orofacial granulomatosis?

A
  • Can get this at any age
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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
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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
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25
Q

What are 3 examples of oesophageal disorders?

A
  • Dysphasia
  • Dysmotility disorders
  • GORD
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26
Q

What is dysphasia?

A
  • Problems swallowing
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27
Q

What happens in dysmotility disorders? (2 points)

A
  • Fibrosis

- Neuromuscular dysfunction (nerves and muscles don’t work anymore)

28
Q

What Is GORD?

A
  • Gastro oesophageal reflux disease
29
Q

What is a common reason for dysphasia? (2 points)

A
  • Food getting stuck

- Can be intermittent or constant

30
Q

What are the different types of dysphasia? (3 points)

A
  • Functional (anxiety, nervous system)
  • dysmobility
  • May be external compression
31
Q

What is a more common name for GORD?

A
  • Heartburn
32
Q

What are the 3 main causes of GORD?

A
  • Defective lower oesophageal sphincter
  • Impaired lower clearing
  • Impaired gastric emptying
33
Q

What are 3 consequences of GORD?

A
  • Ulceration
  • Inflammation
  • Metaplasia
34
Q

What is metaplasia?

A

The change in the type of adult cells in a tissue to form abnormal cells for that tissue

35
Q

What are common signs & symptoms of GORD? (4 points)

A
  • Epigastric burning
  • Dysphasia
  • GI bleeding
  • Severe pain (mimics MI)
36
Q

Epigastric burning is a common symptom of GORD. What makes this worse? (3 points)

A
  • Lying down
  • Bending
  • Pregnancy
37
Q

Severe pain is a common symptom of GORD. What causes this?

A
  • Oesophageal muscle spasm
38
Q

In GORD, dysphasia can be caused by oesophagitis, stricture or dysmotility. What do these 3 terms mean?

A

Oesophagitis = inflammation of the oesophagus

Stricture = Abnormal narrowing of a canal in the body

Dysmotility = muscles not working as they should

39
Q

What is Barrett’s Oesophagus? (2 points)

A
  • Recurrent acid reflux into the lower part of the oesophagus
  • Metaplasia of the oesophageal lining to gastric type mucosa
40
Q

What is Barrett’s oesophagus associated with?

A
  • Malignant change - adenocarcinoma
41
Q

What is a hiatus hernia?

A
  • Where part of the stomach is in the THORAX
42
Q

What are the symptoms of a hiatus hernia similar to?

A
  • Similar to GORD symptoms
43
Q

Are hiatus hernias more common in men or women?

A
  • Women
44
Q

How can you manage GORD? (5 points)

A
  • Stop smoking
  • Lose weight & avoid triggering activity
  • Antacids
  • H2 blockers & PPI’s (ranitidine & omeprazole)
  • Increase GI motility & gastric emptying)
45
Q

Why can stopping smoking manage GORD?

A
  • It improves the sphincter
46
Q

Where in the body does peptic ulcer disease affect? (3 points)

A
  • Oesophagus, stomach, duodenum

- ANY acid affected site

47
Q

What are the causes of peptic ulcer disease? (3 points)

A
  • High acid secretion (duodenal)
  • Normal acid secretion (stomach)
  • Drugs (NSAIDS, steroids)
48
Q

Where can peptic ulcer disease occur if there is EXCESSIVE acid production? (2 points)

A
  • Oesophageal ulcers

- Duodenal ulcers

49
Q

Why does peptic ulcer disease occur is there is a NORMAL acid production?

A
  • Due to a reduced protective barrier
50
Q

Which bacterium is involved in peptic ulcer disease when there is NORMAL acid production?

A
  • Helicobacter pylori
51
Q

How do helicobacter pylori cause peptic ulcer disease?

A
  • They cause inflammation of the gastric mucosa so there is a loss of the mucous barrier
52
Q

What effects can helicobacter pylori have? (2 points)

A
  • Gastric ulcers

- Chronic gastric wall inflammation (lymphoma of the stomach)

53
Q

How can you eliminate helicobacter pylori? (2 points)

A
  • TRIPLE THERAPY

- 2 antibiotics and 1 proton pump inhibitor

54
Q

What are the common signs and symptoms of peptic ulcer disease? (3 points)

A
  • Asymptomatic
  • Epigastric burning pain
  • Usually NO physical signs (only when there are complications e.g. bleed)
55
Q

A possible symptom of peptic ulcer disease is epigastric burning pain. When is this worse and how can it be relieved? (3 points)

A
  • Worse before/just after meals
  • Worse at night
  • Relieved by food, alkali and vomiting
56
Q

What investigations can be done for peptic ulcer disease? (4 points)

A
  • Endoscopy
  • Radiology (barium meal)
  • Anaemia (FBC and faecal occult blood test
  • H. pylori - breath, antibiotics, mucosa
57
Q

What are local complications of peptic ulcer disease? (4 points)

A
  • Perforation
  • Haemorrhage
  • Stricture
  • Malignancy
58
Q

What is a systemic complication of peptic ulcer disease?

A
  • Anaemia
59
Q

When can medical treatments of peptic ulcer disease be used? (3 points)

A
  • Reversible problem
  • Lifestyle changes
  • H. pylori present
60
Q

When can surgical treatments of peptic ulcer disease be used? (4 points)

A
  • Stricture
  • Acute bleed
  • Perforation
  • Malignancy
61
Q

What are treatments of peptic ulcer disease? (9 points)

A
  • Medical
  • Stop smoking
  • Small regular meals
  • Eradication therapy
  • Ulcer healing drugs (PPI)
  • Surgical
  • Endoscope
  • Surgical repair (gastrectomy)
  • Vagotomy
62
Q

What is a vagotomy?

A
  • A surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion
63
Q

What medication is used in upper GI disease to reduce acid secretion? (2 points)

A
  • H2 receptor blockers

- Proton pump inhibitors

64
Q

How can you improve the mucosal barrier in upper GI disease? (4 points)

A

Eliminate helicobacter

Inhibit prostaglandin removal:
- NSAID use encourages this - avoid

  • Reduce steroid use
65
Q

Triple therapy is used to eliminate helicobacter pylori. What antibiotic and PPI are used? (3 points)

A

Antibiotics:

  • Amoxycillin
  • Metronidazole

Proton pump inhibitor:

  • Omeprazole

BDS2 BAMS (57 decks)

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