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MD3002 > Treatment of PU and IBD > Flashcards

Treatment of PU and IBD Flashcards

1
Q

What protective mechanisms are there

A
  • Mucous secreting cells (trap bicarb ion, creates gel like barrier, important protective layer)
  • Prostaglandins locally produced (stimulates secretion of mucous and bicarb, dilate mucous blood vessels)
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2
Q

What are the 3 secretagogues

A
  1. Gastrin
  2. ACh
  3. Histamine
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3
Q

Action of Ach

A

Stimulates muscarinic receptors on surface of parietal cells and histamine containing cells

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4
Q

Action of histamine

A
  • Mast cells lying close to parietal cells release histamine
  • Histamine release increased by gastrin and ACh
  • Acts on parietal cell H2 receptors
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5
Q

What damage does H pylori do

A

Damage to protective layer

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6
Q

Associations of H pylori

A
  • Causative factor in gastric and duodenal ulcer
  • Risk factor for adenocarcinoma
  • Strong link with MALT
  • GI reflux disease
  • Dyspepsia
  • Iron deficiency anaemia
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7
Q

What occurs with acute H pylori infection

A
  • Gastric mucosa inflamed with neutrophils and inflammatory cells
  • Marked persistent lymphocytes penetration
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8
Q

What does outcome of chronic H pylori infection depend on

A
  • Pattern of inflammation
  • Host response
  • Bacterial virulence
  • Environmental factors
  • Patient age
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9
Q

Diagnostic tests for H. pylori

A
  • Non-invasive= urea breath test, stool antigen

- Biopsy based= CLO test (aka rapid urease test)

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10
Q

What does H pylori produce

A

Urease (Detected in urea breath test)

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11
Q

Treatment for H pylori

A
  • PPI
  • Amoxicillin
  • Clarithromycin/metronidazole
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12
Q

Examples of PPIs

A
  • Esomeprazole
  • Lansoprazole
  • Omeprazole
  • Pantoprazole
  • Rabeprazole
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13
Q

Indications for PPI used

A
  • H pylori
  • Peptic ulcer disease
  • GORD
  • Reflux oesophagitis
  • Zollinger-Ellison syndrome
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14
Q

How do PPIs work

A
  • Inhibits K+H+ATPase irreversibly
  • Basal and simulated acid secretion reduced
  • Drug is weak base and accumulates in acid environment of the canaliculi of stimulated parietal cell
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15
Q

Side effects of PPIs

A
  • Headaches
  • Confusion
  • Impotence
  • Rashes
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16
Q

Caution of PPIs

A
  • Liver disease
  • Pregnancy
  • Breast feeding
  • May mask symptoms of gastric cancer
17
Q

Action of histamine H2 receptor antagonists

A
  • Competitively inhibits histamine action at all H2 receptors
  • Inhibits histamine, gastric and ACh stimulated acid production
  • Pepsin secretion also falls with reduction in volume of gastric juices
18
Q

When to use H2 receptor antagonists

A
  • Peptic ulcers

- Reflux oesophagitis

19
Q

Examples of H2 receptor antagonists

A
  • Ranitidine (better tolerated)

- Cimetidine

20
Q

Side effects of H2 receptor antagonists

A
  • Diarrhoea
  • Dizziness
  • Muscle pains
  • Transient rashes
  • Alopecia
21
Q

Cautions of H2 receptor antagonists

A

Can mask signs/symptoms of gastric cancer

22
Q

Side effects of cimetidine

A
  • Can interact with androgen receptors (gynaecomastia, decreased sexual function)
  • Inhibits cytochome P450 (slows metabolism and potentiates action of a range of drugs like anticoagulants and tricyclics)
  • Confusion in elderly
23
Q

Define dyspepsia

A

Pain/discomfort in upper abdomen, exacerbated by food

24
Q

Define GORD

A
  • Acid reflux

- Associated with waterbrash

25
Q

General advice for dyspepsia/GORD

A
  • Lifestyle advice (healthy eating, weight reduction)
  • Avoid known precipitants (alcohol, coffee)
  • Raise head of bed and have a main meal well before going to bed
  • Stop NSAIDs when appropriate
26
Q

Over the counter remedies for GORD/dyspepsia

A
  • Antacids= directly neutralise acid and inhibits activity of peptic enzymes (e.g. salts of Mg and Al)
  • Alignates= increases viscosity and adherence of mucus to oesophageal mucosa)
  • Simeticone= antifoaming agent, helps with bloating and flatulence
27
Q

Treatment for H pylori + peptic ulcers

A

Offer H pylori eradication

28
Q

Treatment for NSAID associated ulcers

A
  • Stop use of NSAIDs
  • Offer full dose PPI or H2RA therapy for 8 weeks
  • Offer H pylori eradication therapy if present
29
Q

Treatment for H pylori negative, no NSAID ulcers

A

Offer full dose PPI or H2RA therapy for 4-8 weeks

MD3002 (14 decks)

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