Exam 2 PUD Flashcards by Wendy Pitts

PUD is?

Caused by?

Ulcers in:
U duodenum, stomach
P esophagus

Exposure to acid and pepsin

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PUD risk factors?

U h. pylori
NSAIDs
Hypersecretion (CA)
Smoking

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H. pylori microbe characteristics?

Action?

G- rod
Motile flagellum

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

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NSAIDs action in PUD?

Risk factors? (4)

U gastric mucosa disruption
P duodenal

Age
F
High dose or long use
Comorbidities

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NSAIDs topical effects? (3)

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

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NSAIDs systemic effects? (2)

COX inhib = ↓mucosal PGs ->

mucosa more fragile to acid/pepsin

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Dyspepsia is?

a/w? (3)

Chronic/recurrent up abd discomfort

delayed emptying,
hypersens,
h. pylori

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Dyspepsia presentation? (4)

U post meal fullness/bloating
Early satiety
N
Belching

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Dyspepsia alarm sxs? (6)

WEIGHT LOSS, DYSPHAGIA

V, anemia, jaundice, mass

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Dyspepsia diagnostics? (2)

UGI or endoscopy = standard

r/o h. pylori

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

anti-secretors
prokinetics
smaller/frequent low fat meals

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PUD general presentation: Pain character and location?

If character ∆s, indicates?

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

P complications

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PUD presentation: Other sxs? (5)

Bloat
Belching
Fatigue
Anemia
Dyspnea

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PUD presentation if Duodenal? (5)

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

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PUD presentation if Gastric? (4)

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

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PUD clinical findings? (3)

If obstruction?

If perf?

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

Obstruction = abd distention, high pitch BS

Perf = Rigid abd w/ guarding, rebound tender

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PUD labs? (3)

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

PUD imaging for ulcers?

Esophagogastroduodenoscopy (EGD) = preferred

P UGI

EGD indicated when: Diagnostic? (4)

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

EGD indicated when: Therapy? (3)

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

PUD tx: Goals?

Approach?

Protect and heal mucosa

No caffeine, EtOH, chocolate (↑ acid)
Meds

PUD: Antacids can?

Types and s/e? (2)

Heal minor ulcers

Al hydroxide (Maalox):
s/e constipation

Mg salts (Gaviscon):
s/e diarrh

PUD: H2 blockers can?

Action?

s/e?

Drug names? (4)

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

PUD: PPI can?

Action?

Take when? Why?

Do not take with what?

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)

PPI drug names? s/e?

"-prazole" Prilosec Protonix Prevacid Very safe P prolong metab of warfarin, theophylline

PUD: Cytoprotectant (Sucralfate) action? Take when?

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

PUD: PG Analogs action? Use for what? Drug name? s/e?

↑ bicarb and mucus secretion NSAID-caused ulcers Misoprostol HA Abd pain D

H. pylori tx? (3 options)

Omeprazole + Clarithromycin + Amox x 2 wks or Bismuth subsal (peptobismol) + Metro + TCN x2 wks + H2Block x 4wks or Lansoprazole + Metro + Clarithro x 2 wks

PUD complications?

Perf Hemorr Obstruction Intolerance of meds

Ulcer Perforation presentation? (3)

U acute, severe abd pain: Worse in epigast, radiate low quads or referred shoulder pain P N/V, hemorr

Ulcer Perforation exam findings? (3) Imaging? Tx?

Tachy/Tachy Guarding/Rebound/Rigidity Absent BS CXR = free air Surgery

Pneumoperitoneum is? Best imaging?

Free air in abdomen Upright CXR = air under hemidiaph, double wall sign

PUD: Hemorrhage caused by? Presentation? (5)

Erosion of ulcer into vessel ``` Tachy Syncope HypoTN N/Bloody V Peritonitis sxs if a/w perf ```

PUD: Hemorrhage tx? (4)

Vol replace Gastic lavage IV PPI or H2block Emergent endoscopy

Gastric Outlet Obstruction caused by? Presentation? (5)

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

Gastric Outlet Obstruction exam findings? (2) Tx?

Abd distention Succussion splash over epigast General surgery

PUD: surgical tx?

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

PUD surgery complications: Dumping Syndrome?

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

PUD surgery complications: Blind Loop Synd?

(with BII) | Bacterial overgrowth stops folate/B12 absorp

PUD surgery complications: Afferent Loop Synd?

(with BII) | Distention from retained pancreatic and biliary secretions