Flashcards in Gastro - Diseases of the Stomach Deck (85)
What are gastric ulcers?
deep disruption of gastric mucosa down to the muscularis
What is a gastric erosion?
A superficial disruption of the gastric mucosa
What do the parietal cells of the stomach produce? What do their receptors respond to?
Respond to gastrin, Ach, and histamine
What is H+ role in gastric ulcers/erosions?
There is some type of disruption in the gastric mucosal barrier leading to a back-diffusion of H+ which ultimately the accumulation causes damage
What clinical signs are associated with gastric ulcers/erosions?
vomiting, hematemesis, abdominal pain (tucked up abdomen), melena, inappetance, anorexia, and ptyalism (over salivation)
What is found on PE in patients with gastric ulcers/erosions?
Pain on abdominal palpation, pale mm, melena on rectal exam
What can cause gastric ulcers/erosions?
Drugs, mucosal ischemia, CNS disease, renal disease, liver disease, and mucosal inflammation
What drugs can cause gastric ulcers/erosions?
NSAIDs and glucocorticoids
What diagnostic tests can be used for gastric ulcers/erosions?
Rectal exam for melena, CBC, biochemistry, urinalysis, diagnostic imaging, and GI endoscopy
What CBC abnormalities are associated with gastric ulcers/erosions?
anemia +/- regeneration
What will a high BUN on a patient with a suspected gastric ulcer/erosion indicate?
it may suggest GI hemorrhage
What are the treatment goals for gastric ulcers/erosion?
Correct the disease (GI or extra GI), give fluid/electrolytes, monitor the GI bleeding, decrease gastric secretions, and increase cytoprotection
What drugs are histamine H2 antagonists?
Cimetidine, ranitidine, and famotidine
What do histamine H2 antagonists do?
inhibit acid secretion on parietal cells
Histamine H2 antagonists have some efficacy against gastric ulcers/erosions, but what drugs are the best?
proton pump inhibitors (PPI)
What is the duration of action of famotidine?
Which histamine H2 antagonist has prokinetic action?
What histamine H2 antagonist has the least hepatic inhibition? the greatest?
Least inhibition - famotidine
Greatest inhibition - cimetidine
What is sucralfate?
a cytoprotective drug
Why is reflux a problem?
because there are irritative agents in the reflux
What does sucralfate do?
Provides mucosal protection, inactivates pepsins, and promotes PGE
What disease processes is sucralfate effective in?
esophagitis, gastritis, and duodenitis
Why would you want to stagger sucralfate doses when using it with concurrent drugs?
because it may inhibit absorption
What drugs are proton-pump inhibitors?
Omeprazole (PO) and pantoprazole (IV)
What do proton-pump inhibitors do?
Inhibit H/K ATPase pump which reduces gastric volume/acidity
What is one major reason that proton-pump inhibitors are superior to H2 blockers?
because it is rare for them to have adverse effects
What disease processes should proton-pump inhibitors be your first chioce?
esophagitis or gastritis
What do mucosal PGE's do?
Decreases H secretion, increases gastric blood flow, increases HCO3 production, and increases mucus secretion
What is the prostaglandin E1 analogue that is the drug of choice in cases of NSAID induced gastritis?