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Peptic Ulcer Disease/GERD
PUD and GERD info
58
Accounting
Pre-School
02/01/2013

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Cards

Term
3x more likely to have H. Pylori colonization
Definition
First degree relatives
Term
Concomitant disease (PUD risk factor)
Definition
COPD(smoking), Cystic Fibrosis, Cirrhosis
Term
PUD Risk factors
Definition
decreased gastric motility, diet, genetics, stress/psychological (not proven), concomitant diseases
Term
Age > 64 yrs, previous PUD, corticosteroids, high dose NSAIDs, Multiple NSAIDs, anticoagulants, SSRIs
Definition
Established risk factors for NSAID-induced ulcers
Term
cigarettes, alcohol, poor general health, asymptomatic, H2RA users, antacid users, HP
Definition
Possible risk factors for NSAID-induced ulcers
Term
Proteolytic (digestive) enzyme
Definition
Pepsin
Term
stimulates release of Pepsinogen from chief cells in stomach lining
Definition
gastrin
Term
Pepsin is reversibly inactivated at ___ and destroyed at _____
Definition
pH > 4, pH > 7
Term
Mucus, sodium bicarbonate, prostaglandins
Definition
mucosal defense mechanism
Term
secreted by gastric cells to provide a protective layer from noxious substances
Definition
mucus
Term
secreted by gastric and duodenal mucosa- makes mucus viscous and near-neutral pH
Definition
sodium bicarbonate
Term
plays a role in mucosal integrity, maintenance and repair; increases mucus and HCO3 secretion, blood flow, and cellular repair
Definition
Prostaglandins
Term
causatives roles as well as risk of ulcer recurrence
Definition
H. Pylori, NSAIDs/Aspirin, Zollinger-Ellison syndrome, stress related mucosal bleeding (SRMB)
Term
tumors in duodenum that produce gastrin that stimulates acid secretion
Definition
Zollinger-Ellison syndrome
Term
Mobility via flagella to move from lumen of stomach to muscos; produces urease which hydrolyzes urea in gastric juice and converts it to ammonia and carbon dioxide
Definition
Helicobacter Pylori
Term
Alteration of Mucosal Defense (theoretical mechanisms)
Definition
Direct Mucosal Damage; Inflammatory Resposne; Hypergastrinemia
Term
direct irritation of gastric epithelium and prostaglandin suppression
Definition
NSAID Ulcers
Term
PUD Complications
Definition
Upper GI bleeding, Perforation into peritoneal cavity, Gastric outlet obstruction
Term
H. Pylori Detection
Definition
Serology, Urea Breath Test
Term
Proton Pump inhibitors, Histamine 2 Receptor Antagonists, Sucralfate, Antacids, Mucosal protective agent (misoprostol)
Definition
Acid Suppressive Therapy
Term
Antibiotics, Bismuth subsalicylate, acid suppressive therapy (PPI)
Definition
HP Eradications
Term
HP eradication 1st line (Triple therapy)
Definition
PPI BID, Clarithromycin 500 mg BID, amoxicillin 1g BID
Term
HP Eradication Quadruple therapy
Definition
Bismuth 525 mg QID, Tetracycline 500 mg QID, Metronidazole 250 mg-500 mg QID, H2RA or PPI Qday-BID
Term
NSAID Ulcer Prevention
Definition
PPI, Misoprostol, use of COX-2 inhibitor
Term
MOA: prodrugs, absorbed systemically in the duodenum; under acidic conditions they are protonated to active metabolites with IRREVERSIBLY bind to the proton pump
Definition
PPIs
Term
Inhibition of hydrogen, potassium, and ATPase pump of gastric parietal cells
Definition
Inhibition of gastric acid secretion
Term
Indications for PPIS
Definition
duodenal and gastric ulcer treatment, h. pylori, GERD, erosive esophagitis, QD or BID for active ulcer treatment
Term
PPIs heal and relieve abdominal pain faster than
Definition
H2RAs
Term
PPIs Adverse Effects
Definition
headache, nausea, abdominal pain most common; acid reflux rebound
Term
PPI interactions
Definition
substrate, inhibitor, and inducer of several CYP450 enzymes; may increase half life of diazepam, warfarin, digoxin, phenytoin
Term
Cimetidine, Ranitidine, Famotidine, Nizatidine
Definition
Histamine 2 Receptor Antagonists
Term
H2RAs Indications
Definition
OTC formulations- relief of heartburn, acid indigestion, and dyspepsida; prescription- txt of duodenal uler, gastric ulcer, symptomatic relief in gastritis, GERD< active benign ulcer, and hypersecretory conditions
Term
H2RA Adverse Effects
Definition
Headache, GI symptoms (diarrhea, constipation); increased pH can adversely affect absorption of some other drugs (e.g., azole antifungals)
Term
Cimetidine Adverse effects
Definition
gynecomastia, impotence; CYP450 inhibitor: interactions!
Term
MOA: forms a paste-like barrier that adheres to the base of ulcer; requires separation from other medications and can cause constipation
Definition
Sucralfate (Carafate)
Term
synthetic prostaglandin E2 analog that replaces protective prostaglandins
Definition
Misoprostol
Term
used for adjunctive pain control in PUD; effective for 30 min on empty stomach (with food 3 hours)
Definition
antacids
Term
gastritis or multiple superficial erosions (more superficial than PUD)
Definition
Stress ulcers
Term
well documented efficacy for stress ulcers; available IV; Renally eliminated
Definition
H2RA
Term
Chronic symptoms or mucosal damage produced by the reflux of gastric contents into esophagus
Definition
GERD
Term
Medications that may worsen GERD: Decrease LES tone
Definition
anticholinergics, estrogen/progesterone, narcotic analgesics, benzodiazepines, nitrates, CCs, nicotine/alcohol
Term
Medications that may worsen GERD: Direct irritant
Definition
bisphosphonates, aspirin/NSAIDs, iron, quinidine, potassium chloride
Term
Foods that may worsen GERD: Decrease LES tone
Definition
peppermint, spearmint, chocolate, coffee, cola, tea, fatty meal, garlic, onions
Term
Foods that may worsen GERD: Direct Irritant
Definition
tomato juice, coffee, orange juice, spicy foods
Term
Spontaneous transient LES relaxation, increased intra-abdominal pressure, weak or incompetent resting LES
Definition
Defective Lower Esophageal Sphincter (LES)
Term
Responsible for 65% of reflux episodes
Definition
spontaneous transient LES relaxation
Term
Pregnancy, obesity, chronic: constipation, straining, coughing, bending, eating
Definition
increased intra-abdominal pressure
Term
Typical Symptoms of GERD
Definition
heartburn, regurgitation, hypersalivation
Term
Atypical GERD symptoms
Definition
non-coronary chest pain, chronic cough, hoarseness, non-allergic asthma, dental erosions
Term
GERD complications
Definition
Esophageal stricture, Bleeding esophagitis, Esophageal adenocarcinoma
Term
can occur in GERD patients when the epithelial cells in the lower esophagus become damaged as a result of chronic exposure to the stomach chemistry
Definition
Barrett's Esophagus
Term
pathways to GERD treatment
Definition
Neutralize the acid, Slow down acid production, Increase protective barrier, Speed up stomach emptying
Term
mild, infrequent heartburn or dyspepsia (treatment)
Definition
antacids
Term
mild, infrequent heartburn or dyspepsia, GERD (treatment)
Definition
H2 antagonists
Term
moderate-severe GERD or complications
Definition
proton pump inhibitors
Term
Antacids
Definition
quick relief, but short lasting; May increase LES pressure
Term
H2RAs
Definition
longer duration of action than antacids
Term
floats on surface of gastric contents and is refluxed instead of acid; tablets must be chewed and followed by a glass of water; works only in upright position
Definition
Sodium Alginate (Gaviscon)
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