Peptic Ulcer Disease Flashcards
What are the causes of PUD?
Drugs- NSAIDs
Lifestyle factors- smoking, alcohol
Stress
Hypersecretory states
Genetic factors
H. pylori
What are the symptoms of PUD?
Abdominal pain, discomfort, or nausea
Pain located in epigastrium
Pain like hunger pains, gnawing and cramping
Classic ulcer pain aggravated by meals
Duodenal ulcer pain relieved by food
What are the symptoms of PUD?
Abdominal pain, discomfort, or nausea
Pain located in epigastrium
Pain like hunger pains, gnawing and cramping
Classic ulcer pain aggravated by meals
Duodenal ulcer pain relieved by food
Describe acid secretion in stomach
Carbonic anhydrase produces HCO3- and H+
HCO3- exchanged for Cl-
Cl- diffuses into lumen
H+ pumped into lumen by H+/K+ ATPase
What drugs can treat PUD?
Antacids
Antisecretory agents
PPIs
H2 antagonists
What non-pharmaceutical treatment recommended for PUD?
Raising gastric pH above 3 for a few hours a day
Duration of acid suppression determines rate of healing
Rapid healing requires suppression for 18-20 hours a day
What do H2 antagonists do?
Act competively on H2 receptors on gastric parietal cells
Reduce basal acid secretion by 60%
Can treat both gastric and duodenal ulcers
What are examples of H2 antagonists?
Ranitidine
Cimetidine
Famotidine
Nizatidine
What are the side effects of H2 antagonists?
Diarrhoea
Headache
Confusion in elderly
Gynaecomastia with cimetidine
Cimetidine inhibits cytochrome P450 so interacts with warfarin, phenytoin, theophylline
What do PPIs do?
Inhibit pump to block acid secretion
Are irreversible
Inhibition of 90% for up to 24 hours
Return of acid secretion dependent upon synthesis of new enzymes
What are examples of PPIs?
Omeprazole
Lansoprazole
Esomeprazole
Pantoprazole
Rabeprazole
What are the side effects of PPIs?
GI upset- nausea and vomiting, diarrhoea and pain
Headache
Skin rashes
Long term use causes gastric atropy
Omeprazole can stimulate and inhibit cytochrome P450
What are cytoprotective agents?
Methyl analogue of prostaglandin E1
Enhances duodenal bicarbonate secretion
Increases mucosal blood flow
Weak inhibition of gastric secretion
What is an example of cytoprotective agents?
Misoprostol
What does H.pylori cause?
95% patients with gastric ulcer
80% patients with duodenal ulcer
Inflammation of gastric mucosa
