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Peptic Ulcer Disease Flashcards

(70 cards)

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1
Q

Name and explain the 4 major regions of the stomach.

A
  • Cardia: After the oesophageal sphincter. Guards the stomach.
  • Fundus: Expansion reservoir for food
  • Corpus: Production of secretions
  • Pyloric Antrum: mixing of food with gastric secretions, producing chyme.
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2
Q

What is the sphincter of the stomach called and what does it lead to?

A

Pyloric sphincter -> duodenum

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3
Q

What are the exocrine enzymes?

A
  • Hydrochloric acid
  • Pepsinogen
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4
Q

How is pepsinogen activated?

A

When it comes in contact with HCL, it is converted into pepsin. This then breaks down proteins.

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5
Q

What are the endocrine enzymes?

A
  • Gastrin
  • Ghrelin
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6
Q

What are the paracrine enzymes?

A
  • Histamine
  • Somatostatin
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7
Q

What are the 3 types of stomach cells?

A
  • Mucous neck cell: mucus
  • Parietal cell: HCL
  • Chief cell: pepsin
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8
Q

What are the mucosal neck cells and their function?

A
  • Epithelial cells consisting of mucosal cells to provide stomach lining
  • Traps bicarbonate and neutralises acidic environment
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9
Q

What do the mucosal cells contain?

A
  • Mucins
  • Glycoproteins
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10
Q

What is the role of chief cells?

A

Contain pepsinogen which is converted into pepsin for breakdown of proteins.

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11
Q

What is the role of parietal cells?

A

Produce HCL and intrinsic factor
-> Glycoprotein that binds to Vitamin B12

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12
Q

True or False: The parietal cells have 2 receptors.

A

False. They have 3 receptors.

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13
Q

What are the receptors called on parietal cells?

A
  • Histamine H2 receptors
  • Gastrin
  • Muscarinic M3 receptors (ACh)
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14
Q

How does the mucus layer protect the stomach?

A

-Creates a barrier between the enzymes and stomach lining
-Traps bicarbonate ions which neutralise the acidic environment

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15
Q

What is the role of Prostaglandin E2?

A

Stimulates phospholipid and mucus secretion.

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16
Q

How does the bicarbonate get to the HCl?

A

It moves into the bloodstream and diffuses into the mucus layer.

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17
Q

What are the activators of acid secretion in parietal cells?

A
  • Histamine
  • Gastrin
  • Acetylcholine
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18
Q

What other thing is part of the parietal cells which helps move H+ and Cl- into the gastric lumen?

A

Proton pump

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19
Q

What are the 2 functions of mucus?

A
  • Lubrication
  • Protection
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20
Q

What is the 3 functions of HCl?

A
  • Protection
  • Antibacterial
  • Coverts pepsinogen to pepsin
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21
Q

Which cells produce gastrin and what is their function?

A
  • G cells
  • Stimulation of gastric acid secretion
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22
Q

Which cells produce somatostatin and what is their function?

A
  • D cells
  • Inhibition of gastric secretion
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23
Q

What do chief cells contain?

A

Granules containing pepsinogen (Zymogen granules)

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24
Q

How is pepsinogen released from chief cells?

A

Chief cells contain an anticholinergic receptor. Ach binds and activates the receptor which causes the release of pepsinogen.

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25
How is HCl formed in the stomach?
Carbonic acid released a proton which is pumped in the stomach. The chloride ion moves through the chloride channel. H+ + Cl- = HCl
26
What is dyspepsia?
Symptoms of the upper GI Tract.
27
What are the symptoms of dyspepsia?
- Upper abdominal pain/discomfort - Acid reflux/heartburn - Nausea - Vomiting/bloating
28
What are some red flags of dyspepsia?
- Sudden weight loss - Vomiting - Pain when swallowing - Presence of a mass - Anaemia - Bleeding - Dysphagia
29
How do peptic ulcers damage the stomach?
Loss of the mucosal layer -> HCl to damage the cells lining the stomach.
30
Peptic ulcers usually penetrate what?
Muscularis Mucosa
31
Can patient with dyspepsia have peptic ulcer disease?
Some patients can but some don’t.
32
What are the 2 major sites of peptic ulcer disease?
- Gastric ulcers - Duodenal ulcers
33
Duodenal ulcers can be as a result of what?
Increased acid secretion due to: - Increased parietal cell mass - Increased gastrin secretion
34
Which substance can stimulate the increase of gastrin secretion?
Alcohol
35
What are 2 other ways duodenal ulcers can occur and what can these be caused by?
- Decreased inhibition of acid secretion - HCO3- secretion is decreased -> H Pylori
36
Doing what can impair gastric mucosal healing?
Smoking
37
True or False: Genetics can play a role in duodenal ulcers.
True
38
Acid hypersecretion in duodenal ulcers can be due to what?
H Pylori
39
How does gastritis occur from gastric ulcers?
- Epithelial cell damage can occur due to cytokines release from H Pylori. - Parietal cell damage.
40
What are the 4 major complications of Peptic Ulcer Disease?
- Upper GI bleeding: blood in vomit/stools - Ulcer Perforation: Penetrate through stomach wall. Spillage of contents into abdominal cavity. - Pyloric Stenosis: Obstruction of pyloric region from scarring/oedema - Penetration: ulcer penetrates through muscle wall of stomach and continue to organs (liver/pancreas)
41
What are some risk factors of PUD?
- >65 years - Previous peptic ulcers - NSAIDs -> Taken with corticosteroids -> Taken with anticoagulants - can increase risk of haemorrhage
42
What are the 2 main causes of PUD?
- Helicobacter Pylori - NSAIDs
43
How are prostaglandins produced when the membrane is damaged?
1. Membrane becomes damaged 2. Arachadonic acid released and phospholipids 3. Arachadonic acid converted by COX-1 and COX-2 to prostaglandins -> cause pain and inflammation
44
How do NSAIDs work?
They block the COX-1 and COX-2 enzymes -> reduce production of prostaglandins -> reduce pain and inflammation -> can reduce mucus production in the stomach.
45
What is the role of Prostaglandin E2?
Mucus production.
46
Which enzyme and substance is produced for gastric protection?
- COX-1 - Prostaglandin E2 and I2
47
What does H Pylori do to the stomach?
Penetrates the stomach and releases virulence factors which cause inflammation of the gastric mucosa.
48
What does H Pylori release and how does this damage the stomach?
1. It releases mucinase which breaks down the mucosal layer of the stomach. 2. Bacteria get to epithelial layer and releases virulence factors which cause inflammation and infection. 3. Pepsin and HCl also get through. 4. WBCs come and release more inflammatory factors and cytokines.
49
What is used for the diagnosis of peptic ulcers?
Endoscopy -> also done in patients with red flag symptoms
50
What are the advantages and disadvantages of an endoscopy?
- Advantages: sensitive, specific, safe - Disadvantages: invasive and expensive
51
What tests are used for the diagnosis of H Pylori?
- Antibody detection - 13C urea breath test - Stool antigen test
52
What lifestyle changes can help in the treatment of PUD?
- Diet/ weight loss - Reduce alcohol - Stop smoking - Reduce stress - Stop NSAIDs
53
Give some treatments of PUD.
- Antacids - Acetylcholine inhibitors - Histamine H2 receptor antagonists - Proton pump inhibitors - Antibiotics (H Pylori)
54
Which treatment options are available for mild intermittent heartburn?
- Lifestyle changes - OTC antacids - OTC H2-receptor antagonists - OTC PPIs
55
What are the treatment options for mild to moderate GORD?
- Lifestyle changes - H2RAs - PPIs
56
Give an example of a PPI and how does it work?
Omeprazole. -> irreversibly binds to the proton pump and inhibits it.
57
True or False: PPIs will be activated once taken.
False. They are inactive. Carried in bloodstream to parietal cells where when in contact with the acidic environment, they are converted into the active form.
58
What are the clinical uses of PPIs?
- NSAID induced ulcers - Short term treatment of gastric ulcers - Active duodenal/ peptic ulcers
59
True or False: PPIs bind to 1 site on a proton pump.
False. They can bind to different sites on a proton pump.
60
What are some adverse reactions of PPIs?
- Diarrhoea - Headaches - Abdominal Pain -> usually resolve on withdrawal
61
How do histamine receptor antagonists work?
Block histamine receptors in gastric parietal cells, preventing acid secretion.
62
Which is most effective: PPIs or H2RAs?
PPIs
63
Can peptic ulcers heal?
Yes.
64
What are the 3 common H2RAs?
- Cimetidine - Famotidine - Nizatidine
65
How do anticholinergics work?
Block muscarinic M1 receptors which inhibit gastric secretion.
66
What is the clinical uses of anticholinergics?
- Anti-ulcer drug - Peptic ulcer disease
67
Which drug mimics prostaglandin and what is its role?
Misoprostol -> Production of mucus as has a similar chemical structure of prostaglandins. -> gastroprotective therapy
68
What is used for treatment of H Pylori?
Amoxicillin or clarithromycin -> allergy to penicillin -> metronidazole
69
What are antibiotics in H Pylori usually given with?
PPIs
70
Give an example of an anticholinergic?
Pirenzepine

PHA223 (24 decks)

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