Disease of Stomach and Duodenum

Question 1

Portal hypertensive gastropathy treatment

Answer 1

propranolol or nadolol to lower the portal pressures

Question 2

Testing for H. pylori

Answer 2

Serology:Can’t distinguish b/w active vs. inactive infection
**Urea breath test:
Tests for active infection
Off abx for 4 weeks and PPIs for 2 weeks
**Stool antigen testing:
Tests for active infection
Endoscopic biopsy

Question 3

Preferred Treatment for PUD

Answer 3

PPI’s

Question 4

H pylori eradication

Answer 4

Combination therapy is necessary
2-3 antibiotics + PPI or bismuth (“Triple or Quadruple Therapy”)
PPI BID+ clarithromycin + Amoxicillin
If PCN allergy:
PPI BID+ clarithromycin + metronidazole

Question 5

PUD Treatment after Triple or Quadruple therapy

Answer 5

Small ulcer (<1 cm) no further treatment

Large or complicated ulcer :
continue PPI for up to 6 weeks post completion If eradicated most patients don’t need further acid suppression therapy

Question 6

Zollinger-Ellison Syndrome (Gastrinoma)

Answer 6

Gastrin secreting gut neuroendocrine tumor
Causes hypergastrinemia from increase acid secretion
Cause less then 1% of PUD
usually malignant and resectable

Question 7

Gastroparesis

Answer 7

Delayed gastric emptying in the absence of a mechanical obstruction
secondary to diabetes, surgery, idiopathic