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 (B)</p> Signup and view all the answers

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

<p>Their absorption into systemic circulation (C)</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 (D)</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 (D)</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 (A)</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 (D)</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 (A)</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 (C)</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 (A)</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 (A)</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 (D)</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 (B)</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 (C)</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 (D)</p> Signup and view all the answers

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

<p>Cataracts (C)</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 (D)</p> Signup and view all the answers

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

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

What is a rare but serious side effect of methotrexate?

<p>Pneumonitis (D)</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 (A)</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 (C)</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 (B)</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 (B)</p> Signup and view all the answers

What is the potential side effect of using Cyclosporin?

<p>All of the above (D)</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 (B)</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 (D)</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 (A)</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 (B)</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 (B)</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 (A)</p> Signup and view all the answers

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

<p>elevated blood pressure (A)</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 (C)</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 (C)</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 (D)</p> Signup and view all the answers

What is the effect of serotonin on the submucosal plexus?

<p>Stimulates glands to produce secretions (B)</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 (A)</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 (B)</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 (A)</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 (D)</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 (C)</p> Signup and view all the answers

How do glucocorticoids modulate the immune response?

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

What is the primary cause of constipation in modern society?

<p>Laxative abuse (D)</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 (B)</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 (B)</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 (D)</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 (B)</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 (D)</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 (D)</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 (D)</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 (A)</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 (D)</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 (D)</p> Signup and view all the answers

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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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