Peptic Ulcer Disease (PUD) and Gastrointestinal Disorders
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Questions and Answers

What is the primary cause of Peptic Ulcer disease in 95% of cases?

  • Weak mucosal barrier caused by genetics
  • Infection with H.pylori bacteria or use of NSAIDs (correct)
  • Excessive gastric acid secretion due to benign pancreatic tumor secretions
  • Insufficient production of mucosal protective agents

    • What is the mechanism of action of antacids in reducing gastric acid?

  • They stimulate the production of mucosal protective agents
  • They suppress the growth of H.pylori bacteria
  • They inhibit the production of gastric acid by blocking H2 receptors
  • They react with gastric acid to form water and salt, diminishing acidity (correct)

    • What is a potential long-term complication of using non-systemic antacids?

  • Hypertension
  • Diarrhea
  • Kidney dysfunction (correct)
  • Alkalosis

    • Which of the following is NOT a type of medication used to treat GERD and PUD?

    <p>Anti-diabetic medications</p> Signup and view all the answers

    What is the primary difference between systemic and non-systemic antacids?

    <p>Their absorption into systemic circulation</p> Signup and view all the answers

    What is the effect of excessive gastric acid secretion on the mucosal barrier?

    <p>It overwhelms the mucosal barrier</p> Signup and view all the answers

    Which of the following medications is a synthetic prostaglandin E1 analog that stimulates mucosal cells to increase mucous and bicarbonate secretion?

    <p>Misoprostol</p> Signup and view all the answers

    Which of the following proton pump inhibitors is available in combination with sodium bicarbonate to enhance absorption?

    <p>Omeprazole</p> Signup and view all the answers

    What is the primary mechanism of action of Proton Pump Inhibitors (PPIs) in reducing gastric acid secretion?

    <p>Irreversible inhibition of H/K ATPase</p> Signup and view all the answers

    What is the major advantage of Proton Pump Inhibitors (PPIs) over H2 blockers in the management of GERD?

    <p>Faster relief and healing</p> Signup and view all the answers

    What is the major contraindication for the use of Misoprostol in women?

    <p>Childbearing age without reliable birth control</p> Signup and view all the answers

    Which of the following cells plays a crucial role in regulating gastric acid secretion by releasing histamine?

    <p>ECL cells</p> Signup and view all the answers

    What is the primary function of mucous cells in the gastric mucosa?

    <p>To protect the stomach lining from corrosive gastric acid</p> Signup and view all the answers

    Which of the following is NOT a stimulus for the activation of parietal cells?

    <p>Somatostatin release from D cells</p> Signup and view all the answers

    What is the net result of the proton pump action on parietal cells?

    <p>H+ ions are pumped into the lumen of the stomach</p> Signup and view all the answers

    Which of the following is a consequence of the inhibition of gastric acid secretion?

    <p>Decreased risk of NSAID-induced GI complications</p> Signup and view all the answers

    What is the primary mechanism of action of thiopurine derivatives in deactivating key processes in T lymphocytes that lead to inflammation?

    <p>Inhibiting ribonucleotide synthesis, inducing T cell apoptosis by modulating cell signaling</p> Signup and view all the answers

    What is a common side effect of glucocorticoids, such as prednisone, that affects the eyes?

    <p>Cataracts</p> Signup and view all the answers

    Which of the following medications is used for relapsed or active Crohn's disease refractory or intolerant to ASA or thiopurine?

    <p>Methotrexate</p> Signup and view all the answers

    How do glucocorticoids, such as prednisone, modulate the immune response?

    <p>By inhibiting phospholipase 2</p> Signup and view all the answers

    What is a rare but serious side effect of methotrexate?

    <p>Pneumonitis</p> Signup and view all the answers

    What is the mechanism of action of Cyclosporin in reducing inflammation?

    <p>Inhibits the production of cytokine IL-2</p> Signup and view all the answers

    What is the purpose of combining Cyclosporin with folic acid (B9)?

    <p>To reduce the intermediary metabolism of folic acid</p> Signup and view all the answers

    What is the role of calcineurin in the activation of NFAT proteins?

    <p>It activates NFAT proteins by de-phosphorylating them</p> Signup and view all the answers

    What is the indication for using Infliximab in Crohn's disease?

    <p>To treat fistulizing Crohn's disease</p> Signup and view all the answers

    What is the potential side effect of using Cyclosporin?

    <p>All of the above</p> Signup and view all the answers

    What is the primary indication for the use of Cyclosporin in Inflammatory Bowel Disease?

    <p>Active and chronic symptoms refractory to corticosteroids</p> Signup and view all the answers

    What is the mechanism of action of Aminosalicylates in reducing inflammation in Inflammatory Bowel Disease?

    <p>Modulation of the immune response</p> Signup and view all the answers

    What is a potential side effect of using Infliximab in Inflammatory Bowel Disease?

    <p>Increased risk of infection</p> Signup and view all the answers

    What is the role of Thiopurines in the treatment of Inflammatory Bowel Disease?

    <p>Modulating the immune response in active and chronic symptoms</p> Signup and view all the answers

    How does Mesalamine differ from Sulfasalazine?

    <p>Mesalamine is a pro-drug, while Sulfasalazine is an active ingredient</p> Signup and view all the answers

    What is the mechanism by which corticosteroids inhibit inflammatory pathways in the context of inflammatory bowel disease?

    <p>by decreasing IL transcription and suppressing arachidonic acid metabolism</p> Signup and view all the answers

    What is a potential side effect of NSAIDs in patients with renal impairment?

    <p>elevated blood pressure</p> Signup and view all the answers

    Which of the following is an indication for the use of Olsalazine in patients with inflammatory bowel disease?

    <p>treating active disease and reducing colorectal cancer risk</p> Signup and view all the answers

    How do corticosteroids cause anti-inflammatory effects in the nucleus of inflamed cells?

    <p>by inhibiting GRE receptors and inducing cis-repression</p> Signup and view all the answers

    What is a contraindication for the use of Olsalazine in patients with inflammatory bowel disease?

    <p>allergy to aspirin</p> Signup and view all the answers

    What is the effect of serotonin on the submucosal plexus?

    <p>Stimulates glands to produce secretions</p> Signup and view all the answers

    What is the primary function of delta cells in the GI tract?

    <p>To inhibit acid production in the stomach and motor activity of the intestines</p> Signup and view all the answers

    What is the effect of excess HCl in the lumen on delta cells?

    <p>It activates the production of somatostatin</p> Signup and view all the answers

    What is the effect of gastrin excess on the gastric mucosal barrier?

    <p>It increases the production of mucous in the pyloric region</p> Signup and view all the answers

    What is the effect of bacterial and viral infections on the gastric mucosal barrier?

    <p>It disrupts the mucosal barrier and causes symptoms such as diarrhea and pain</p> Signup and view all the answers

    What is a potential side effect of using monoclonal antibodies in treating diverse diseases?

    <p>Infusion reaction and reactivation of TB</p> Signup and view all the answers

    How do glucocorticoids modulate the immune response?

    <p>By suppressing the activity of T-cells</p> Signup and view all the answers

    What is the mechanism of action of bulking agents in treating constipation?

    <p>By triggering the stretch receptors of the intestinal wall</p> Signup and view all the answers

    What is the indication for using monoclonal antibodies in treating diseases?

    <p>Active chronic disease refractory or intolerant to steroids or immunosuppression</p> Signup and view all the answers

    What is the primary cause of constipation in modern society?

    <p>Laxative abuse</p> Signup and view all the answers

    What is the primary mechanism of action of Simethicone in relieving painful symptoms associated with gas?

    <p>Altering the elasticity of mucous-coated bubbles, causing them to rupture and release gas</p> Signup and view all the answers

    What is the primary indication for using Metronidazole in the treatment of AAD and colitis?

    <p>To treat h. pylori infection</p> Signup and view all the answers

    How do glucocorticoids, such as prednisone, modulate the immune response in Inflammatory Bowel Disease?

    <p>By inhibiting the production of inflammatory cytokines</p> Signup and view all the answers

    What is a potential side effect of using Vancomycin in the treatment of AAD and colitis?

    <p>Renal impairment</p> Signup and view all the answers

    What is the mechanism of action of Bismuth in reducing inflammation in Inflammatory Bowel Disease?

    <p>By disrupting bacterial cell walls and decreasing fluid secretion</p> Signup and view all the answers

    What is the primary mechanism of action of Adsorbents in controlling diarrhea in Inflammatory Bowel Disease?

    <p>By adsorbing intestinal toxins or microorganisms</p> Signup and view all the answers

    What is the role of the chemoreceptor trigger zone in the vomiting reflex pathway?

    <p>It responds directly to chemical stimuli in the blood or cerebrospinal fluid</p> Signup and view all the answers

    What is the primary indication for using Anti-flatulence drugs in Inflammatory Bowel Disease?

    <p>To relieve painful symptoms associated with gas</p> Signup and view all the answers

    What is the mechanism of action of Metronidazole in treating AAD and colitis?

    <p>It inhibits the growth of C. difficile and reduces toxin production</p> Signup and view all the answers

    What is a potential side effect of using glucocorticoids, such as prednisone, in Inflammatory Bowel Disease?

    <p>Ocular effects, such as cataracts and glaucoma</p> Signup and view all the answers

    Study Notes

    Peptic Ulcer Disease (PUD)

    • Disruption of mucosa and submucosa
    • Caused by:
      • 95%: H. pylori bacteria or NSAIDs (aspirin, arthritis meds)
      • 5%: benign pancreatic tumor secretions or idiopathic
    • Increased acidity leads to ulcers

    Treatment Options for Heartburn, GERD, and PUD

    • Antacids:
      • Systemic: calcium-based, can cause alkalosis, not for long-term use
      • Non-systemic: does not produce alkalosis, may cause diarrhea, affects kidney function over time
    • H2 receptor blockers:
      • Cimetidine: inhibits estrogen metabolism, suppresses gastric secretion by 70%
      • Ranitidine (Zantac): removed by FDA due to potential cancer risk
    • Proton Pump Inhibitors (PPIs):
      • Strong inhibitors of gastric acid secretion
      • Prevent pumping of gastric acid during 24 hours
      • Preferred drug, take while fasting
      • Examples: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid), esomeprazole (Nexium), rabeprazole (Aciphex)
    • Misoprostol:
      • Stimulates prostaglandin E1 receptors to reduce gastric acid secretion
      • Increases mucosal cell production and thickens mucosal bilayer
      • Side effects: diarrhea, pain, cramps, uterine contractions (contraindicated in women of childbearing age)

    Gastric Anatomy and Function

    • Pyloric glands:
      • Pit: surface mucous cells, mucous neck cells, G cells
      • Base: deep mucous, G cells, D cells, enterochromaffin (EC), ECL
    • Mucous cells:
      • Produce mucous to protect stomach lining from acid
      • Found in necks of gastric pits and surface
    • Parietal cells:
      • Responsible for gastric acid secretion
      • Aided by Ach, histamine, and gastrin
    • Enterochromaffin-like cells (ECL):
      • Neuroendocrine cells found in gastric mucosa
      • Release histamine to stimulate gastric acid secretion

    Inflammatory Bowel Disease (IBD)

    • Ulcerative colitis:
      • Diffused mucosal and submucosal inflammation limited to colon
      • Symptoms: bloody diarrhea, colicky acute pain, urgency, tenesmus
    • Crohn's disease:
      • Patchy transmural inflammation affecting any part of GI tract
      • Symptoms: abdominal pain, diarrhea, weight loss, intestinal obstruction
    • Treatment:
      • Aminosalicylates for mild symptoms
      • Corticosteroids for moderate symptoms
      • Thiopurines for active and chronic symptoms
      • Methotrexate for active and chronic symptoms
      • Cyclosporin for active and chronic symptoms refractory to corticosteroids
      • Infliximab for active and chronic symptoms

    Other GI Disorders

    • Constipation:
      • Treated with dietary modification, laxatives (bulking agents, osmotic laxatives, stimulant drugs, stool softeners)
    • Anti-flatulence drugs:
      • Simethicone (detergent) alters elasticity of mucous-coated bubbles
      • Adsorbents (Aluminum hydroxide and Methylcellulose) control diarrhea by adsorbing intestinal toxins or microorganisms
      • Bismuth decreases fluid secretion and inhibits pepsin
    • Emesis (Vomiting):
      • Provoked by seeing something repulsive, ingesting a toxin, or motion sickness
      • Two brainstem sites have key roles in the vomiting reflex pathway: chemoreceptor trigger zone (CTZ) and area postrema

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    Description

    Learn about the causes and symptoms of peptic ulcer disease, including the role of H. pylori bacteria and NSAIDs, and how to treat heartburn, GERD, and PUD with antacids and H2 receptor blockers. Discover the importance of diet alteration and medication in managing gastrointestinal disorders.

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