Disorders of gastric acid and ulceration

Question 1

What red flags should you look our for in patients suffering with dyspespia?

Answer 1

bleeding, recurrent vomitting, weight loss, dysphagia (problems swallowing) or if its unexplained, not responding to treatment and over 55

Question 2

What lifestyle advise would you primarily give to a patient suffering from dyspepsia?

Answer 2

Avoid alcohol, smoking cessation,reduce weight, raise the head of the bed, avoid triggers such as fats, stoo medication that may cause dyspepsia

Question 3

Aluminium containing antacids can cause __. What do you have to look out for in patients with renal impairment?

Answer 3

Constipation. Risk of aluminium accumulation

Question 4

Mg containing compounds can cause __

Answer 4

Diarrhea

Question 5

What cautions should you take in bismuth containing compounds?

Answer 5

Can cause neurotoxicity and encephalopathy if absorbed

Question 6

What cautions should you take in calcium containing compounds?

Answer 6

Prolonged high doses can cause hypercalcemia and alkalosis and can precipitate milk-alkali syndrome

Question 7

What is the purpose of simeticone added in with an antacid?

Answer 7

To relieve flatulence or hiccup in palliative care

Question 8

What is the initial treatment for hpylori eradication?

Answer 8

One week triple therapy regimen which includes, clarithromycin and either amoxicillin or metronidazole with a PPI, the antibiotics can be mixed and matched if they have previously taken antibiotics of the same classes

Question 9

What is the success rate of hpylori eradication therapy?

Answer 9

85%, failure usually indicates resistance or poor compliance

Question 10

What should you change, if any, if the ulcer is large or complicated by haemorrhage or perforation?

Answer 10

Continue PPI only for up to 3 weeks

Question 11

What are the alternatives for PPIs?

Answer 11

H2 receptor antagonist (ranitidine) or misoprostol (prostaglandin analogue)

Question 12

What is the recommended treatment for pts on a non selective nsaid?
Treat ulcer with ppi and continue in healing phase
Treat ulcer with ppi and switch to misoprostol in healing phase
Treat ulcer with ppi and switch nsaid to Cox 2 selective inhibitor an continue ppi in healing phase

Answer 12

All the above

Question 13

What is sucralfate?

Answer 13

A complex of aluminium hydroxide and sulfated sucrose protecting mucosa from acid pepsin attack in ulcers.

Question 14

What is zollinger Ellison syndrome and what is the recommended treatment?

Answer 14

Tumour or hyperplasia in the islets cells in the pancreas overproduces gastric acid resulting n recurrent peptic ulcers. Ppi>H2 receptor antagonist

Question 15

What are H2 receptor antagonists used for?

Answer 15

Functional dyspepsia (non ulcer), idiosyncratic with no alarm features, nsaid associated ulcers, reduce risk of acid aspiration in obstetrics patients

Question 16

What should you look out for in pts taking H2 receptor antagonists?

Answer 16

Can mask signs and symptoms of gastric cancer

Question 17

What are the restrictions for P supply of cimetidine/famotidine/ranitidine?

Answer 17

Sold for over 16yrs, no more than 2 weeks supply for relief of heartburn, dyspepsia, hyperacidity and for prevention of these symptoms when associated with food and drink or prophylactic treatment of nocturnal heartburn (cimetidine only)

Question 18

What is misoprostol also used for without relation to GI disorders?

Answer 18

Abortion, use if pregnancy has been excluded in woman of child bearing age. Induces uterine contractions and teratogenic at first trimester . Manufacturer advises avoiding breastfeeding

Question 19

A high dose PPI administered IV is given ___

Answer 19

Following endoscopic treatment of severe peptic ulcer bleeding to reduce rebleeds.

Question 20

What condition is PPI's not used for?
Hpylori eradication
NSAID associated ulcers
Dyspepsia
GORD
Ab cramps
Zollinger Ellison Syndrome
Peptic ulcer bleeding
Cystic fibrosis

Answer 20

Ab cramps

Question 21

What dose reduction is recommended after an NSAID induced ulcer has healed?

Answer 21

Trick qu, dose should normally not be reduced because asymptomatic ulcer deterioration may occur

Question 22

At the start of summer a patient comes in with a skin rash on his forearms and complains about pains in his elbows after being out in the sun all week, upon looking at his PMR he has recently taken metformin for newly diagnosed DM, he is also on long term ramirpil for HT and takes naproxen with a PPI following a leg fracture a few months ago. How do you respond?

Answer 22

Possible SCLE, subcutaneous lupus erythematosus, dug induced SCLE can ocur weeks, months or even years after exposure to PPI, if a pt develops skin lesions in sun exposed areas with joint pain advise to avoid sun exposure, discontinue PPI unless it if for a serious acid related condition. On most cases symptoms resolve on PPI withdrawal, topical or oral steroid for SCLE if doesnt resolve within a few weeks. Pt may be at risk of same reaction with another PPI. The risk is very low

Question 23

What monitoring requirements are recommenced for someone undergoing long term PPI treatment?

Answer 23

Serum mg conc as can cause hypomagnesaemia which is more common if tsking it for more than a year. risk increased if taking drugs with the same risk (digoxin)

Question 24

GORD is non associated with what symptom?
Heartburn
Dysphagia
Acid regurgitation
Oesophagitis
Weight loss
Ulceration
Strictures

Answer 24

Weight loss

Question 25

What lifestyle changes would you advise or GORD patients?

Answer 25

Avoid excess alcohol, smoking and aggravating foods
Weight reduction
Raise the head of the bed

Question 26

After initial management of GORD with a PPI how do you carry on with treatment?

Answer 26

When symptoms abate treatment is titrated down to a level which maintains remission, this can be done by reducing the dose or taking intermittently. Alternatively switching to a H2 receptor antagonist.

Question 27

When should omeprazole be used in pregnancy?

Answer 27

Reserved for woman with several or complicated GORD

Question 28

What drug is licensed for symptomatic control of food allergies
Cetirizine
Ranitidine
Dicyclovrrine
Chlorphenamine
Hydrocortisone

Answer 28

Chlorphenamine