Disorders Of Gastric Acid Amd Ulceration

Question 1

What are the symptoms of dyspepsia?

Answer 1

Upper abdominal pain
Fullness
Early satiety
Bloating
Belching
Nausea

Question 2

What causes dyspepsia?

Answer 2

Indigestion
GORD
Gastritis
Gastric or duodenal ulcers

Question 3

What symptoms need urgent endoscopic referral?

Answer 3

Anaemia
Loss of weight
Anorexia
Recently changed, unexplained new dyspepsia in 55+ unresponsive to treat,met
Malaena, dysphagia, haematemesis, recurrent vomiting

Question 4

What do you use to treat uninvestigated dyspepsia?

Answer 4

Antacids
PPI for 4 weeks if symptoms persist

H. Pylori test if unresponsive to PPI

Question 5

What do you use for investigates functional dyspepsia?

Answer 5

H. Pylori test

PPI or H2 antagonist for 4 weeks

Question 6

How do antacids work?

Answer 6

Neutralises stomach acid

Provides immediate symptom relief in 15-30 mins

Question 7

How do the alginates work?

Answer 7

Forms viscous gel raft on top of stomach contents to prevent reflux

Question 8

What are the antacids?

Answer 8

Aluminium salt - constipating 
Calcium salt
Magnesium salt - laxatimg
Potassium salt
Sodium salt

Question 9

Which antacids have low sodium?

Answer 9

Maalox
Mucogel

Altacite plus

Question 10

What are the alginates?

Answer 10

Albinos acid

Sodium alginate

Question 11

How do you take antacids?

Answer 11

After each main meal and at bedtime when required

Question 12

What are the antacid interactions that impair the absorption of drugs?

Answer 12

Tetracyclines
Quinolones
Bisphosphonates

Leave a 2 hour gap

Question 13

What are the antacid interactions?

Answer 13

Damage enteric coatings by increasing gastric pH

High sodium content - fluid retention, avoid in hypertension, heart, liver or kidney failure

Avoid in sodium restricted diet e.g. lithium

Question 14

How do PPIs work?

Answer 14

Inhibits gastric acid secretion by blocking hydrogen-potassium ATPase of the gastric parietal cell

It is the most effective antisecretory drug

Question 15

What are the PPIs?

Answer 15

Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole

Question 16

Which PPI needs to be taken 30-60 mins before food?

Answer 16

Lansoprazole

Question 17

What PPI is safe in pregnancy?

Answer 17

Omeprazole

Question 18

How do you take PPIs?

Answer 18

Swallow whole

Do not crush

Do not take indigestion remedies 2 hours before or after you take this medicine

Question 19

What is the dose for PPIs?

Answer 19

Lowest effective dose for shortest period

Question 20

What are the side effects of PPIs?

Answer 20

GI upset

Hypomagnesaemia
Fractures
Rebound acid secretion, protracted dyspepsia

Question 21

What is the MHRA advice for PPIs?

Answer 21

Very low risk of subacute cutaneous lupus erythematosus

Avoid sun exposure

Question 22

What are the interactions with omeprazole?

Answer 22

Clopidogrel- reduced antiplatelet effect

Methotrexate- decreased clearance of methotrexate

Question 23

How do H2 receptor antagonists work?

Answer 23

Reduces gastric acid secretion by blocking H2 receptors in the gastric parietal cell

Antisecretory drug

Question 24

What are the H2 receptor antagonists?

Answer 24

Cimetidine - enzyme inhibitor
Famotidine
Nizatidine
Ranitidine

Question 25

What are the side effects of the H2 antagonists?

Answer 25

``` Headaches Rashes Dizziness Diarrhoea Psychiatric reactions ```

Question 26

What are the cautions in H2 receptor antagonists?

Answer 26

Masks symptoms of gastric cancer

Question 27

Can misoprostol be used in pregnancy?

Answer 27

No. Teratogenic

Question 28

Can misoprostol be used in duodenal ulceration?

Answer 28

Yes

Question 29

What are the side effects of misoprostol?

Answer 29

Colic and diarrhoea are dose limiting side effects | Diarrhoea is common and can occasionally be severe and require withdrawal

Question 30

Can sucralfate be used in duodenal ulcers?

Answer 30

Yes

Question 31

What are the side effects of sucralfate?

Answer 31

Bezoar formation 1 hour before meals / 1 hour gap between enteral feeds

Question 32

What is used to treat H. Pylori ulcers?

Answer 32

1 week triple therapy PPI BD + Clarithromycin + amoxicillin or metronidazole

Question 33

If a patient is penicillin allergic how do you treat H. Pylori?

Answer 33

PMC PPI Metronidazole Clarithromycin

Question 34

If a patient has recently been treated with a macrolide how do you treat H. Pylori?

Answer 34

PPI Amoxicillin Metronidazole

Question 35

If a patient has recently been treated with metronidazole how do you treat H. Pylori?

Answer 35

PPI Amoxicillin Clarithromycin

Question 36

How do you treat NSAID induced ulcers?

Answer 36

Withdraw NSAID | PPI or H2 antagonist/misoprostol

Question 37

What do you use for prophylaxis of NSAID induced ulcers?

Answer 37

PPI if at risk PPI with cox-2 selective NSAID

Question 38

How do you treat mild GORD symptoms?

Answer 38

Antacid + alginate H2 receptor antagonists/PPI

Question 39

How do you treat severe symptoms of GORD?

Answer 39

PPI for 4-6 weeks

Question 40

How do you treat GORD in pregnancy ?

Answer 40

Antacids or alginates | Omeprazole for complicated GORD

Question 41

How do you treat GORD in children?

Answer 41

Common in infant and resolves after age 12-18 months Mild-moderate GORD thickened feeds or alginates

Question 42

How do you diagnose H. Pylori?

Answer 42

C-urea breath test kits Do not perform test within 4 weeks of antibacterial Or 2 weeks treatment with antisecretory drug