3 - Peptic Ulcer Disease Flashcards
ulcers go down to what layer of stomach
muscularis mucosa
3 characteristics of stomach ulcer pain
epigastric
relates to acid cycle
episodic
2 MC causes of ulcers
H pylori drug use (mostly NSAIDs)
3 conditions H pylori infection causes
atrophic gastritis
peptic ulcers
gastric cancer
H pylori serology - what is/isn’t it useful for
not generally recommended
sensitivity/specificity good but not great
Ab can remain for yrs after infection > CAN’T use to confirm eradication
preferred tests for H pylori
urea breath test
stool antigen test
when would you do an endoscopy to dx h pylori?
when there is a strong possibility of cancer or barrett’s esophagus - geographic (Korean, Japanese), or alarm features (wt loss, mass, bleeding, etc)
general principles of h pylori tx
always >1 abx
acid suppression at same time
duration 14 d
need to confirm cure after
abx used for h pylori (and which 4 are used in standard 4 drug therapy?)
amoxicillin, bismuth, clarithromycin (macrolides), metronidazole**, tetracycline, furazolidone, floroquinolones
+ PPI** for acid suppression
**used in 4 drug therapy
which is better for tx of h pylori - sequential or concomitant therapy?
both are equally effective
ulcer complications
bleeding
perforation
obstruction
penetration
surgical tx for peptic ulcer dz
cut vagus nerve branches
remove antrum
gastrectomy
zollinger ellison syndrome - what is it
non beta cell tumor of pancreas that makes gastrin (tends to be malignant) > sustained levels of acid hypersecretion
sx of zollinger ellison syndrome
gastric acid hypersecretion
ulcers in unusual locations
diarrhea
parathyroid adenomas tend to be associated
atrophic gastritis
no of few parietal cells > little to no acid secreted in stomach
