Gastrointestinal disease

6 Gastrointestinal disease



Questions




Question 1


Please explain the role of the sympathetic nervous system in the gastrointestinal tract.



Question 2


What is the difference between a submandibular salivary gland swelling and swelling of a salivary lymph node?



Question 3


How does Barrett’s oesophagus develop?



Question 4


Is it recommended to treat asymptomatic endoscopically diagnosed reflux oesophagitis with acid suppression and/or antireflux measures?



Question 5


Is it recommended to give a young patient, diagnosed endoscopically to have mild reflux oesophagitis, life-long proton pump inhibitors (PPIs) to prevent the development of Barrett’s oesophagitis?



Question 6


Is it safe to give a patient with reflux oesophagitis who is on proton pump inhibitors (PPIs) for treatment of acid suppression, aspirin in antiplatelet doses (75–325 mg per day)?



Question 7


Does a combination of magnesium and aluminium hydroxide salts, taken as antacid for reflux oesophagitis, have serious long-term adverse effects?



Question 8


In the treatment of reflux oesophagitis with a proton pump inhibitor (PPI), should the PPI be life long or given for 4–8 weeks, as mentioned by the drug manufacturers?



Question 9


Would a patient who suffers with reflux oesophagitis as a result of a hiatus hernia, and who is not responsive to proton pump inhibitors (PPIs), benefit from a highly selective vagotomy?



Question 10



1. What are the causes of belching and what appropriate drug can be used?

2. What are the effects of smoking on the gastrointestinal tract and what is its role in peptic ulcer disease?


Question 11


Dear authors, why are gastric ulcers more common along the lesser curve, near the pylorus of the stomach?



Question 12


What is the best time of day to administer omeprazole, and why?



Question 13


Is it safe to use the drugs omeprazole and ranitidine during pregnancy?



Question 14


Are non-steroidal anti-inflammatory drugs harmful to the stomach when taken parenterally, for example by intravenous or intramuscular routes?



Question 15


Is it safe to give a patient with a past history of bleeding peptic ulcer aspirin in an antiplatelet dose of 75–325 mg?



Question 16


Is sulpiride effective in the treatment of a peptic ulcer or gastro-oesophageal reflux disease (GORD)?



Question 17


Is clopidogrel gentle on the stomach?



Question 18


Is there a drug interaction between non-steroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs)?



Question 19


Do antacids enhance mucosal resistance in the gastric mucosa? If so, please indicate the mechanism.



Question 20


Is there a drug interaction between antacids and H2-receptor blockers?



Question 21


Does the combination of aluminium and magnesium hydroxide, given as an antacid, decrease the absorption of omeprazole if these are co-administered to help relieve heartburn quickly?



Question 22


Should proton pump inhibitors be used with caution in patients with renal impairment?



Question 23


Has cisapride been withdrawn from the market because of the danger of ventricular fibrillation?



Question 24


In peptic ulcer disease:



1. What are the indications for an upper gastrointestinal endoscopy?

2. As this is an invasive procedure, is an oesophagogastroduodenoscopy (OGD) or barium meal X-ray preferable?


Question 25


Is telithromycin as, or more, effective than clarithromycin in the treatment of Helicobacter pylori? If so, what is the recommended dosage and how long should treatment be continued?



Question 26


Currently favoured regimens for eradication of Helicobacter pylori are triple therapy with a proton pump inhibitor along with two antibiotics for 1 week. For example:



• Omeprazole 20mg + metronidazole 400mg and clarithromycin 500mg (all twice daily).

• Omeprazole 20mg + clarithromycin 500mg and amoxicillin 1g (all twice daily).

Resistance to amoxicillin has not yet been demonstrated.


Previously, regimens such as omeprazole, metronidazole, amoxicillin and clarithromycin were recommended; are these regimens no longer used? The reason behind this question is the ‘sky-high’ cost of clarithromycin in Pakistan, which is inversely proportional to patient compliance (that is, low-cost regimens tend to have a higher rate of compliance).



Question 27


What is the difference between the management of a gastric and of a duodenal ulcer?



Question 28


How does omeprazole suppress Helicobacter pylori?



Question 29


Does omeprazole cause rebound hyperacidity? Does this also apply to H2-blockers?



Question 30


On (K&C 7e, p. 249), you state that the postsynaptic neurotransmitter that inhibits the relaxation of lower oesophageal sphincter (LOS) is nitric oxide (NO). I have understood NO to promote relaxation of LOS by acting on the non-adrenergic, non-cholinergic (NANC) inhibitory neurones, which inhibits the action of cholinergic excitatory neurones. Could you please explain this paradox?



Question 31


It is stated that nitric oxide (NO) inhibits the relaxation of the lower oesophageal sphincter (LOS) and that sildenafil is given for treating achalasia. As far as I know, sildenafil acts to increase the guanine monophosphate (GMP), just as NO uses the same mechanism to relax the LOS. Could you explain this paradox?



Question 32


In Kumar and Clark Clinical Medicine you mention that auscultation is not important in cases of gastrointestinal disorders, but Harrison’s Principles of Internal Medicine gives this as being of equal importance because succussion splash and bowel sounds can help in presumptive diagnosis. Succussion splash indicates gastric obstruction (e.g. gastroparesis) and likewise bowel sounds can help determine the status of developing ileus. Would you agree that this is therefore a diagnostic tool?



Question 33


Is it hazardous to give aspirin in the antiplatelet doses (75–325 mg/day) to a patient with a past history of haematemesis proved to be from a peptic ulcer?



Question 34


How can upper gastrointestinal (GI) bleeding be distinguished from lower GI bleeding by using faecal analysis?



Question 35


In upper gastrointestinal bleeding, without knowing the cause or source of bleeding, why do we give proton pump inhibitors (PPIs, e.g. omeprazole)? What is the role of these, if the source of bleeding is not peptic or duodenal ulcer?



Question 36


Why is the incidence of coeliac disease increasing in many countries?



Question 37


Are small amounts of gluten harmful to a patient with coeliac disease?



Question 38


I refer to the treatment of complications related to diverticular disease. Under ‘bleeding’ you mention that ‘Persistent bleeding can often be arrested by undertaking an “instant” barium enema, which acts to plug the offending diverticulum’. When I mentioned this to my consultant he said he had never heard of this. Could you clarify how this would work and where I could obtain more information?



Question 39


In children with abdominal pain and fever, does a white cell count help establish a diagnosis of appendicitis?



Question 40


I have always been taught that ulcerative colitis only affects the large bowel with some associated proctitis. I read in your chapter on gastrointestinal disease that it can cause mouth ulcers and am now confused.



Question 41


In pseudomembranous colitis, what is the first treatment of choice, metronidazole or vancomycin?



Question 42


Is Crohn’s disease considered as an autoimmune disease. If it is, are there other predisposing factors to it other than genetics? If it is not, what is its nature?

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Gastrointestinal disease

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