Ch. 335 - PUD Flashcards
the end result of inflammation caused by an imbalance between cytoprotective and cytotoxic factors in the stomach and duodenum, manifests with varying degrees of gastritis or frank ulceration.
PUD
Final common pathway for the development of ulcers
action of acid and pepsin-laden contents of the stomach on the gastric and duodenal mucosa and the inability of mucosal defense mechanisms to allay those effects
Peptic ulcers are deep mucosal lesions that disrupt the ___ layer of the gastric or duodenal wall
muscularis mucosa
Gastric ulcers are generally located on the ___ of the stomach, and 90% of duodenal ulcers are found in the ___
lesser curvature, duodenal bulb
Primary peptic ulcers are more often chronic and ___ in location
Duodenal
Secondary peptic ulcers are more often acute and ___ in location
Gastric
___ ulcers are most often associated with Helicobacter pylori infection
Primary ulcers
By ___ of age, gastric acid secretion approximates adult values
3-4 yr
pH of the stomach contents is
1-2
Excessive acid secretion is associated with ___ (3)
1) a large parietal cell mass, 2) hypersecretion by antral G cells, and 3) increased vagal tone
Results in increased or sustained acid secretion in response to meals and increased secretion during the night
Increased vagal tone
Substance released by vagus nerve that promotes acid production
Acetylcholine
Substance released by enterochromaffin cells that promotes acid production
Histamine
Substance released by G cells of antrum that promotes acid production
gastrin
Mucus production and secretion in the stomach are stimulated by
PGE2
method of choice to establish the diagnosis of peptic ulcer disease
Esophagogastroduodenoscopy
Secretagogues that promote gastric acid production
1) Ach release by vagus 2) Histamine release by enterochromaffin cells 3) Gastrin release by G cells of antrum
Mediators that decrease gastric acid secretion and enhance mucin production
Prostaglandins
Classic symptom of peptic ulceration present only in a MINORITY of children and presents as
Epigastric pain alleviated by ingestion of food
H. pylori: ?urease ?catalase ?oxidase
Yes, yes, yes
T/F Chronic colonization with H.pylori can predispose children to a significantly increased risk of developing duodenal ulcer, gastric cancer, or MALT lymphomas
T
Recommended eradication therapies for H.pylori-associated disease in children
1) Amox+Clarith+PPI 2) Amox+Metro+PPI 3) Clarith+Metro+PPI
First-line drugs for the treatment of gastritis and PUD in children
H2 receptor antagonists and PPIs
MOA: H2 receptor antagonist
Inhibit binding of histamine at H2 receptor of gastric parietal cell
MOA: PPI
Block gastric parietal cell H+/K+ ATPase pump in dose-dependent fashion, reducing BASAL and STIMULATED gastric acid secretion
