Term
| What are the causes of GORD? |
|
Definition
1. decreased lower oesophageal sphincter pressure
2. increased lower oesophageal sphincter relaxation
3. aggravated by alcohol |
|
|
Term
| What is the oesophageal acid clearance time? |
|
Definition
| duratration of time the oesophageal mucosa remains in contact acidified |
|
|
Term
| What physiology neutralises acid in GORD? |
|
Definition
1. salavation
2. perstalsis |
|
|
Term
| What are the symptoms of GORD? |
|
Definition
Pyrosis (heartburn)
Regurgitation
Chest pain
Sour tasting fluid in throat
Globulas sensation
Chronic hoarseness
Non-allergenic asthma
Worse after meal, during exercise, laying down, bending over |
|
|
Term
|
Definition
| Clinical history + symptoms |
|
|
Term
| What is the lifestyle managment of GORD? |
|
Definition
limit alcohol, fatty foods, spicy foods, acidic foods/drinks, coffee
take small frequent meals
avoid laying down after meals
avoid food and drink 2-3 hours before bedtime
elevate bedhead
weight management
smoking cessation |
|
|
Term
| What is the symptomatic treatment of GORD? |
|
Definition
antacids; OR
antacid + alginate; OR
H2 receptor antagonist - famotidine 20mg, nizatidine 150mg, ranitidine 150mg |
|
|
Term
| How is persistant GORD treated? |
|
Definition
PPI - esomeprazole 20mg, omeprazole 20mg, lansoprazole 30mg, pantoprazole 40mg, rabeprazole 20mg
morning symptoms 30 min before b'fast |
|
|
Term
| What are the AE of long term PPI therapy? |
|
Definition
gastric atrophy, intestinal metaplasia in H.pylori patients
bacterial gastroenteritis
travellor's diarrhoea |
|
|
Term
| How is GORD managed in infants? |
|
Definition
slightly elevate bedcot head
thicken foods and breast milk with precooked food thickener
2nd line = PPI |
|
|
Term
| What are the causes of PUD? |
|
Definition
Helicobacter pylori
NSAIDs
Stress related - Zollinger-Ellison Syndrome
Hyperscretory condition
Cigarette smoking
Viral infections
Chemotherapy
Other bacterial infections |
|
|
Term
| What stimulates HCl secretion? |
|
Definition
| Gastrin which is secreted by antral gastric cells |
|
|
Term
| What actions does gastrin have? |
|
Definition
stimulates HCl release from parietal cells; AND
activates enterochromaffin-like cells,which releases histamine, which mobilises proton pump |
|
|
Term
| How does pepsin contribute to ulcer formation? |
|
Definition
| Disrupts mucus-bicarbonate barrier (which decreases mucosal defense) |
|
|
Term
| What promotes colonization of gastric mucosa by H. pylori? |
|
Definition
| high duodenal acid levels |
|
|
Term
| What does H. pylori colonization of mucosa cause? |
|
Definition
Inflammation
Gastric metaplasia
More colonization |
|
|
Term
| What promotes ulcer formation? |
|
Definition
High acid levels
Abnormal gut motility |
|
|
Term
| What are the symptoms of PUD? |
|
Definition
DU - epigastric pain
GU - midepigastric pain, gnawing sood after meals
burning ache relieved after meals
anorexia, N/V, belching, bloating, heartburn |
|
|
Term
|
Definition
Endoscopy
H.pylori - breath test, blood test, stool test |
|
|
Term
|
Definition
Antisecretory agents
H.pylori eradication |
|
|
Term
| What is H. pylori triple therapy? |
|
Definition
PPI - omeprazole or esomeprazole 20mg bd (7 days)
amoxicillin 1g d (7 days)
clarithromycin 500mg bd (7 days)
|
|
|
Term
| What antibiotic is used in H. pylori triple therapy if allergic to penicillin? |
|
Definition
| metronidazole 400mg bd (7 days) |
|
|
Term
| What is the H. pylori quadruple therapy? |
|
Definition
PPI 20mg bd
colloidal bismuth subcitrate 120mg qd
tetracycline 500mg qid
metronidazole 200mg tid, 400mg n
7-14 days |
|
|
Term
| What is the H. pylori triple therapy for children? |
|
Definition
| lansoprazole, amoxicillin, clarithromycin |
|
|
Term
| What is maintenance therapy for PUD? |
|
Definition
|
|
