Exam 2 PUD

Question 1

PUD is?

Caused by?

Answer 1

Ulcers in:
U duodenum, stomach
P esophagus

Exposure to acid and pepsin

Question 2

PUD risk factors?

Answer 2

U h. pylori
NSAIDs
Hypersecretion (CA)
Smoking

Question 3

H. pylori microbe characteristics?

Action?

Answer 3

G- rod
Motile flagellum

Attacks mucosa ->
∆s pH and ↑↑ acid secretion ->
↓ bicarb and mucus secretion

Question 4

NSAIDs action in PUD?

Risk factors? (4)

Answer 4

U gastric mucosa disruption
P duodenal

Age
F
High dose or long use
Comorbidities

Question 5

NSAIDs topical effects? (3)

Answer 5

U in stomach
Cytotoxic (erodes mucosa)
∆s immune response (↑ leukocytes against mucosa)

Question 6

NSAIDs systemic effects? (2)

Answer 6

COX inhib = ↓mucosal PGs ->

mucosa more fragile to acid/pepsin

Question 7

Dyspepsia is?

a/w? (3)

Answer 7

Chronic/recurrent up abd discomfort

delayed emptying,
hypersens,
h. pylori

Question 8

Dyspepsia presentation? (4)

Answer 8

U post meal fullness/bloating
Early satiety
N
Belching

Question 9

Dyspepsia alarm sxs? (6)

Answer 9

WEIGHT LOSS, DYSPHAGIA

V, anemia, jaundice, mass

Question 10

Dyspepsia diagnostics? (2)

Answer 10

UGI or endoscopy = standard

r/o h. pylori

Question 11

Dyspepsia tx: If - for h. pylori? (3)

Answer 11

anti-secretors
prokinetics
smaller/frequent low fat meals

Question 12

PUD general presentation: Pain character and location?

If character ∆s, indicates?

Answer 12

Mid-epigastric pain: burning, gnawing,
P radiation to back

P complications

Question 13

PUD presentation: Other sxs? (5)

Answer 13

Bloat
Belching
Fatigue
Anemia
Dyspnea

Question 14

PUD presentation if Duodenal? (5)

Answer 14

Episodic pain
2-3 hrs post meal
Wakes at night
Relieved w/ food or antacid
Uncommon: N/V, weight loss

Question 15

PUD presentation if Gastric? (4)

Answer 15

Continuous pain
Worse 30 min post meal
Minimal relief from antacids
N/V, weight loss

Question 16

PUD clinical findings? (3)

If obstruction?

If perf?

Answer 16

P mild epigast tenderness
BS = N
DRE to r/o blood

Obstruction = abd distention, high pitch BS

Perf = Rigid abd w/ guarding, rebound tender

Question 17

PUD labs? (3)

Answer 17

Urease Breath Test for CO2 = 13C or 14C

CBC to r/o anemia

TO R/O H. Pylori:

ENDOSCOPIC Bx -> rapid urea test of specimen

Serum for IgG and h. pylori Abs
Stool Antigen Test
Cx

Question 18

PUD imaging for ulcers?

Answer 18

Esophagogastroduodenoscopy (EGD) = preferred

P UGI

Question 19

EGD indicated when: Diagnostic? (4)

Answer 19

Define defects seen on UGI
Bx
F/U of treated ulcers
Eval dysphagia, dyspepsia, abd pain

Question 20

EGD indicated when: Therapy? (3)

Answer 20

Remove FB, polyps
Sclerosis/banding of esoph varices
Coag of hemorrhage

Question 21

PUD tx: Goals?

Approach?

Answer 21

Protect and heal mucosa

No caffeine, EtOH, chocolate (↑ acid)
Meds

Question 22

PUD: Antacids can?

Types and s/e? (2)

Answer 22

Heal minor ulcers

Al hydroxide (Maalox):
s/e constipation

Mg salts (Gaviscon):
s/e diarrh

Question 23

PUD: H2 blockers can?

Action?

s/e?

Drug names? (4)

Answer 23

Heal duodemun ulcers

Inhibit histamine in parietal cells ->
↓ acid and H+

SAFEST class
Cimetidine slows metabolism of:
warfarin
TCA
quinidine (arrhy)
phenytoin (seizures)
theophylline (asthma)

Tagamet, Zantac, Pepcid, Axid

Question 24

PUD: PPI can?

Action?

Take when? Why?

Do not take with what?

Answer 24

Heal peptic ulcers

Post powerful acid secretion inhibitor:
Inhibits H+/K+ exchange

Before meal
Work on stimulated parietal cells

Any other anti-secretors (H2-blocks)

Question 25

PPI drug names?

s/e?

Answer 25

“-prazole”
Prilosec
Protonix
Prevacid

Very safe
P prolong metab of warfarin, theophylline

Question 26

PUD: Cytoprotectant (Sucralfate) action?

Take when?

Answer 26

No direct acid secretion effect,
Forms adhesive lining against pepsin, acid, bile

Empty stomach

Question 27

PUD: PG Analogs action?

Use for what?

Drug name?

s/e?

Answer 27

↑ bicarb and mucus secretion

NSAID-caused ulcers

Misoprostol

HA
Abd pain
D

Question 28

H. pylori tx? (3 options)

Answer 28

Omeprazole + Clarithromycin + Amox x 2 wks

or

Bismuth subsal (peptobismol) + Metro + TCN x2 wks + H2Block x 4wks

or

Lansoprazole + Metro + Clarithro x 2 wks

Question 29

PUD complications?

Answer 29

Perf
Hemorr
Obstruction
Intolerance of meds

Question 30

Ulcer Perforation presentation? (3)

Answer 30

U acute, severe abd pain:
Worse in epigast, radiate low quads or referred shoulder pain

P N/V, hemorr

Question 31

Ulcer Perforation exam findings? (3)

Imaging?

Tx?

Answer 31

Tachy/Tachy
Guarding/Rebound/Rigidity
Absent BS

CXR = free air

Surgery

Question 32

Pneumoperitoneum is?

Best imaging?

Answer 32

Free air in abdomen

Upright CXR = air under hemidiaph, double wall sign

Question 33

PUD: Hemorrhage caused by?

Presentation? (5)

Answer 33

Erosion of ulcer into vessel

Tachy
Syncope
HypoTN
N/Bloody V
Peritonitis sxs if a/w perf

Question 34

PUD: Hemorrhage tx? (4)

Answer 34

Vol replace
Gastic lavage
IV PPI or H2block
Emergent endoscopy

Question 35

Gastric Outlet Obstruction caused by?

Presentation? (5)

Answer 35

U PUD

Chronic mid-epigast pain
PERSISTENT V post meal
BLOATING
Epigast fullness
Wgt loss

Question 36

Gastric Outlet Obstruction exam findings? (2)

Tx?

Answer 36

Abd distention
Succussion splash over epigast

General surgery

Question 37

PUD: surgical tx?

Answer 37

Part gastrectomy (cut out dz'd part of stomach):
BI includes duodenum
BII includes jejun

Question 38

PUD surgery complications: Dumping Syndrome?

Answer 38

Acute onset of anxiety, weakness, tachy, diaphoresis, palp post meal

Question 39

PUD surgery complications: Blind Loop Synd?

Answer 39

(with BII)

Bacterial overgrowth stops folate/B12 absorp

Question 40

PUD surgery complications: Afferent Loop Synd?

Answer 40

(with BII)

Distention from retained pancreatic and biliary secretions