Therapeutics- Upper GI Tract Flashcards
(48 cards)
What are the causes of gastric ulcers
H. pylori (60%), NSAIDs (30%), carcinoma (5%), others (5%)- neoplasia, Crohn’s, stress, ZE syndrome. 75mg of aspirin daily increases the risk of developing gastric ulcers. If gastric ulcer’s don’t heal it means that they are cancerous.
What are the causes of duodenal ulcers
H. pylori (85%), NSAIDs (10-14%), rare causes (1%)- Zollinger Ellison, Crohn’s, stress
What are the causes of gastrooesophageal reflux disease
GORD: Food and drink, obesity, pregnancy, alcohol, smoking and NSAIDs are all risk factors which make people more prone to reflux
What does functional dyspepsia present with
Bloating/ belching, feeling very full after eating small amount of food, delayed gastric emptying etc. H. pylori however the NNT (number needed to treat for one patient to benefit) = 14
What are the treatment options for functional dyspepsia
PPI, prokinetic (e.g. domperidone) Prokinetic agents, or prokinetics, are medications that help control acid reflux. Prokinetics help strengthen the lower esophageal sphincter (LES) and cause the contents of the stomach to empty faster. This allows less time for acid reflux to occur, tricyclic (e.g. amitriptyline) for pain management and relaxation techniques via cognitive therapy or hypnotic techniques. Relaxation techniques are very important
What is the biggest upper GI risk symptom
Dysphagia and anaemia, yet only 1/30 result in something bad
Clinical features of dyspepsia
Peptic ulcers, reflux, cancer etc. Peptic ulcers result in epigastric pain. Acid reflux starts at the bottom of the sternum and goes to the back of the throat and is worse after meals, spicy food or when lying on your back
Clinical features of GORD
GORD is worse after a meal, after eating certain foods, whilst lying flat and during pregnancy- hormonal changes result in relaxation of the lower oesophageal sphincter.
Gastric ulcers- patient was taking ibuprofen.
What must you do if patients have any ‘red flag’ symptoms
Send them for an endoscopy
What are red flag symptoms
Hematemesis- vomiting blood; Malena- blood in stools; GI bleeding; Unintentional weight loss; Dysphagia; Persistent vomiting; Epigastric mass; >55 and persistent/ recent onset dyspepsia; Iron deficiency anaemia; Anaemia with indigestion
What features are typical of dysphagia
The lower end of the oesophagus which is irregular, raised and has a mass lesion
What does it mean if there is old food in the oesophagus
Food is not emptying properly
What are the features of oesophagitis
Streaks of inflammation due to acid in the oesophagus
What happens in Barret’s oesophagus
The gastro-oesophageal junction is in the wrong place which means that gastric mucosa is too high in the oesophagus. The two types of epithelium which occur at the junction should be near the mucosal folds. A person with Barret’s oesophagus has a higher risk of developing malignancies
What is a possible complication of a stomach ulcer
Arterial bleed in the stomach. The bleed occurs as the end of the blood vessel has been cut due to the stomach ulcer (perforation). If an arterial bleed in the stomach occurs then adrenaline is injected which results in vasoconstriction. Adrenaline wears off after 1-2 hours, therefore metal clips are used to permanently constrict the blood vessel.
What do upper gut symptoms require
A lifestyle treatment plan
What are therapeutics used
Not just drugs but includes lifestyle, reassurance and possibly surgery
What is the most common cause of GORD
A hiatus hernia
Why does a hiatus hernia result in reflux
Not usual to excrete excess acid, instead it is just acid moving into the oesophagus
What are antacids
Weak bases that react with gastric acid decreasing pepsin activity (inactive pH>4) resulting in having a soothing effect
Describe H2 receptor antagonists (H2RA’s)
H2 receptor antagonists act as inhibitors of gastric acid secretion. H2 receptor antagonists bind to Gs which prevent them from binding to histamine. They inhibit histamine-, gastrin- and acetylcholine-stimulated acid secretion, pepsin secretion also falls with the reduction in volume of gastric juice. These agents decrease both basal and food-stimulated acid secretions by 90%, also numerous clinical trials indicate that they also promote healing of duodenal uclers
What are examples of H2RA’s
Ranitidine/ cimetidine
Why do H2 receptor antagonists decrease the need for surgery and the likelihood of developing a stomach ulcer
They have a major effect
What are possible side effects of H2RA’s
Impotence, gynaecomastia (anti-androgen). Cimetidine is a cytochrome p450 inhibitor which also impairs metabolism of warfarin, phenytoin etc
