lecture 2

Question 1

dyspepsia is

Answer 1

indigestion

Question 2

% of population with dyspepsia

Answer 2

40

Question 3

after endoscopy , what is commonly seen

Answer 3

40% have GORD, 40 have non ulcer dyspepsia, 13 % have ulcer disease

Question 4

symptoms of dyspepsia

Answer 4

reflux, heartburn, pain, nausea/vomiting

Question 5

name of ulcer in stomach vs duodenum

Answer 5

gastric ulcer - stomach, duodenal ulcer - duodenum

Question 6

what is required to form a peptic ulcer

Answer 6

acid and pepcin

Question 7

what makes stomach corrosive

Answer 7

low pH of 1 or 2

Question 8

name of ulcer which goes fully through stomach wall

Answer 8

perferated ulcer

Question 9

why doesnt the stomach digest itself

Answer 9

alkaline mucus - forms a gel layer subsance on top layer of stomach/intestine to neutralise stomach acid

Question 10

use of tight junctions

Answer 10

found between epithelial cells , they hold the epithelial cells close together so that acid cant leak between them - if these are distrupted an ulcer may form

Question 11

peptic ulcers formed when theres impaired

Answer 11

mucosal defence and peptic acid present

Question 12

how can nsaids cause ulcers

Answer 12

reduce prostaglandin production, which then reduces bicarbonate production ( bicarbonates neutralise the acid and prostaglandins also promote blood flow through mucosa so less of the bad stuff gets flushed away from epithelial cells)

Question 13

what factors can increase risk of ul er

Answer 13

smoking , stress, genetics

Question 14

mucin is

Answer 14

a genetic component which protects the musosal Layer

Question 15

H pylori can cause ulcers because it affects

Answer 15

pepsin secretion and impairs mucosal barrier

Question 16

how does heavy drinking or smoking cause ulcers

Answer 16

causes inflammation of the stomach which leads to breakdown of mucosal defence

Question 17

what is the epigastrium

Answer 17

upper section of the stomach, just below the rib cage

Question 18

peptic ulcer pain is usually located where and how is the pain described

Answer 18

in the epigastrium and usually doesnt radiate - pain described as burning, gnawing or as hunger pains

Question 19

ulcer pain and meals

Answer 19

gastric ulcer pain is aggrevated by meals, duodenal is relieved by meals

Question 20

H pylori is seen is 40% of individuals- how is this presented in gastric ulcer vs duodenal

Answer 20

95% of patients with gastric ulcer and 80% of those with duodenal ulcer

Question 21

where does h pylori effect and what is the effect

Answer 21

lower stomach, causes inflammation of the gastric mucosa (gastritis)

Question 22

How do you test for the presence of H pylori

Answer 22

Serologic evaluation (but this can reflect previous exposure)
Urea breath test ( - as h pylori contain large amounts of the urease enzyme which convert urea to NH3 and CO2)
Stool antigen tests ( detect antigen released by organisms present in the stomach)

Question 23

what happens if you dont get rid of h pylori

Answer 23

80% of ulcers will reoccur within a year

Question 24

How is acid secreted in the stomach

Answer 24

carbonic anhydrase produces bicarbonate and h , bicarbonate is exchanged for a cloride ion, which diffuses into the lumen , the h is pumped into lumen by h/k atpase - leads to acid in lumen

Question 25

drugs which treat peptic ulcer disease

Answer 25

antacids/antisecretory agents these raise pH to promote healing , you also need to eradicate h pylori by pharmacological treatments

Question 26

examples of histamine receptor antagonists

Answer 26

cimetidine, ranitidine, nizatidine, famotidine

Question 27

now do h2 receptor antagonists work

Answer 27

acts competetibely on h2 receptors on gastric parietal cells and reduce the basal acid secretion by 60%

Question 28

problem with h2 receptor antagonists as treatment

Answer 28

relapse is common after treatment stops can cause diarrhoea, headaches, confusion (in elderly), cimetidine - gynaecomastia (due to anti-androgen effect) and it also inhibits P450 system ( causes potential interactions with warfarin, phenytonin and theophylline)

Question 29

PPI examples

Answer 29

omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole

Question 30

PPIs are irreversible. How does acid secretion return?

Answer 30

dependent on the synthesis of new enzymes (H/K atpase) ( need to make new cells?)

Question 31

adverse effects of PPIs

Answer 31

gastrointestinal upset, headache, skin rashes, gastric atrophy in long term use. omeprazole - has both stimulatory and inhibitory effecys on CYP450 system

Question 32

Treatment to eradicate H pylori infection

Answer 32

Use triple therapy: PPI, amoxicillin and clarithromycin/metronidazole if pen allergic: PPi, clarithromycin and metronidazole

Question 33

When can cytoprotectie agents not be used

Answer 33

in pregnancy

Question 34

how does h pylori get trapped - effecting the stomach

Answer 34

it detects the pH gradient and it moves towards the raised pH (of surface of epithelial cell) where it gets into the mucus gel => trapped

Question 35

what is serologic evaluation

Answer 35

blood testing

Question 36

how is a urea blood test carried out

Answer 36

given a capsule containing carbon 13 form of urea. If h pylori is present the urea is broken down into 2x NH2 snf CO2 - this is better test than seologic but is more expensive

Question 37

is an antacid or an antisecretory better at treating peptic ulcers

Answer 37

antisecretory agenst

Question 38

when is acid secretion worse

Answer 38

during the night

Question 39

why do males need to be wary of taking cimetidine

Answer 39

they can get gynaecomastia

Question 40

which acid stimulators do PPI stop

Answer 40

all 3

Question 41

eg of a cytoprotective agent

Answer 41

mistoprostol

Question 42

WHen is misoprotol given

Answer 42

alongsided a NSAID to stop the formation of an ulcer

Question 43

how does a cytoprotective work

Answer 43

enhances bicarbonate secretion in duodenum, weakly inhibits gastric acid secretion through activation of prostaglandin receptor on parietal cells , increases mucosal blood flow

Question 44

what is zollinger-ellison syndrome

Answer 44

a rare disorder whoch can cause gastric/duodenal ulcers or in jejunum too due to massive gastric acid hyper secretion caused due to gastrin secreting tumour in the pancreas/duodenum (gastrinoma) which stimulates acid secretuon in the stomach

Question 45

what causes gord

Answer 45

lower oesopgafeal spincter not working properly so the acid from the stomach comes back up into oesophagus - burning

Question 46

drugs for treating GORD

Answer 46

antacids and antacid/alginate combinations , drugs which inhibit gastric acid secretion , drugs which act on oesophageal/ gastric motility

Question 47

who gets diagnosed with gord

Answer 47

patients with long-term GORD

Question 48

wjat is barretts oesophagus

Answer 48

replacement of normal stratified squamous epitheliym by columnar epithelium cells with goblet cells

Question 49

barretts oesophagus can lead to

Answer 49

cancer (oesopageal adenocarcinoma)