10: Adult Ulcers

Question 1

What is your biggest acute concern with ulcers?

Answer 1

Perforation: Can bleed out within minutes.

Question 2

Which etiologic factor for PUD (H. pylori, NSAIDs, smoking, alcohol/coffee)?

Inhibits gastric mucosal prostaglandin synthesis and has direct erosive effect.

Answer 2

NSAIDs

Question 3

Who has the highest prevalence of H. pylori?

Answer 3

• Underdeveloped countries (70% infected).
• Only 30-40% of Americans are infected.

Question 4

Why must H. pylori be treated?

Answer 4

• Causes 90-95% of duodenal ulcers and 40-70% of gastric ulcers.
• Untreated raises lifetime risk of gastric cancer and lymphoma.

Question 5

3 types of ulcer disease.

Answer 5

1. Esophageal
2. Peptic (gastric and duodenal)
3. Lower intestine

Question 6

What is the most common symptom of PUD?

Answer 6

• Dyspepsia
• Described as gnawing, burning, soreness, or tightness.
• Associated symptoms include belching, bloating, flatulence, nausea, early satiety, and vomiting.

Question 7

Treatment for NSAID-induced PUD.

Answer 7

• Stop NSAIDs
• Avoid alcohol, steroids, and anticoagulants until healed
• Add H2 blocker to reduce acid

Question 8

When do you use lifestyle modifications for PUD?

Answer 8

Initially. Then if endoscopy + for ulcers, medical treatment is started.

Question 9

Which etiologic factor for PUD (H. pylori, NSAIDs, smoking, alcohol/coffee)?

Does not directly damage mucosa, but makes it more susceptible to acid and pepsin, which can thin the lining and create erosion.

Answer 9

H. pylori

Question 10

What bacteria causes PUD?

Answer 10

H. pylori

Question 11

Who should be tested for H. pylori?

Answer 11

• Active gastric or duodenal ulcers
• Confirmed history of PUD without previous H. pylori testing
• History of gastric MALT lymphoma
• Uninvestigated dyspepsia in high endemic areas

Question 12

What is the pathogenesis of ulcer formation?

Answer 12

An offending factor causes loss of the mucosal surface, creating a thinning of the tract which can lead to bleeding, scarring, and perforation.

Question 13

Treatment for H. pylori-induced PUD.

Answer 13

• Triple cocktail:
  
  • ABX
  • PPI
  • Carafate (taken before meals, coats stomach)

Question 14

Lifestyle modifications in ulcer disease.

Answer 14

• Avoid caffeine
• Decrease emotional stress
• Decrease/stop smoking (improves H2 blocker therapy)

Question 15

Normally, PUD is treated based on clinical findings. What characteristics require an immediate endoscopy and why?

Answer 15

• 40+ yo
• Early satiety
• Unintentional weight loss
• Heme + stool
• Anemia
• Could be signs of gastric cancer

Question 16

Which NSAIDs are the most problematic in PUD?

Answer 16

• Ketorolac
• Indocin
• Naproxen
• (Ibuprofen lowest risk)

Question 17

What are the 6 common causes of ulcers?

Answer 17

1. H. pylori (most common)
2. NSAIDs (most common)
3. ETOH
4. Caffeine
5. Steroids
6. Family hx

Question 18

Which etiologic factor for PUD (H. pylori, NSAIDs, smoking, alcohol/coffee)?

Stimulate acid secretion and compromise mucosal barrier.

Answer 18

Alcohol/Coffee

Question 19

Which etiologic factor for PUD (H. pylori, NSAIDs, smoking, alcohol/coffee)?

Inhibits prostaglandin production. Delays healing of ulcers.

Answer 19

Smoking

Question 20

How is H. pylori transmitted?

Answer 20

Fecal-Oral or possibly Oral-Oral