Gastritis/PUD/H.Pylori Flashcards
Most common causes of acute hemorrhagic / erosive gastritis
Alcohol, aspirin/nsaids, shock / stress
How is gastritis diagnosed?
Non erosive → biopsy (difficult to dx clinically or endoscopically)
Erosive → endoscopy
Clinical features of gastritis
Non erosive → asymptomatic in most cases
Erosive → bleeding (pain only occurs if it has progressed to ulcers )
Most common cause of PUD
H. Pylori (90% duodenal, 60% gastric)
What are the common s x of duodenal ulcers?
Epigastic pain and burning worse 1-3 hours after a meal, relieved by eating and antacids occurring in. clusters of weeks with subsequent periods of remission
Interrupts sleep
Investigation for peptic ulcer disease
‘Urea breath test if prior hx of h. Pylori
Serology for H. Pylori if no prior hx (will not differentiate b/w current or prior infection
endoscopy →if > 50 and new sx, alarm features, failed repeated trial of therapy. Most accurate
Fobt if anemia present
Upper gi series → avoid if dyspepsia only
Fasting Serum gastric levels - if zollinger Ellison will be elevated
Treatment of peptic ulcer with negative h. Pylori test
Symptom control → avoid alcohol, spices, caffeine, cigarette smoking- maintain ideal weight
Stop NSAIDs and other causative meds if possible
PPI or h2 receptor antagonist X 4 weeks
Reassess in 2-4 weeks
Success → stop treatment
Partial success → repeat x 1
Failure → consider endoscopy / referral
What as the treatment / management of bleeding PUD
ABC, vitals
CBC, electrolytes, bun, Cr, inr, cross and type
Crystalloid and blood products if indicated
May consider ng tube + aspiration to confirm upper gi source
Iv panroprazole 80mg followed by 8mg/h continuous infusion
Erythromycin 250mg 30 min before endoscopy
Endoscopy → non bleeding / low risk → oral ppi,clear fluids 6h post op. Counsel regardin NSAIDs and anti-platelets
Endoscopy → bleeding/visible vessel → clip, thermal coag +/ - epic inj, remove adherent dat, resume oral clear fluids 6 hr post op counsel,, monitor in hospital for rebleed
Interventional radio or surgery if needed
Treatment of H.pylori positive PUD
Symptom control → avoid alcohol, spices, caffeine, cigarette smoking- maintain ideal weight
Stop NSAIDs and other causative meds if possible
Clamet→ clarithromycin 500 mg bid + amoxicillin 1000mg bid + metronidazole 500mg bid + ppi bid X 14 days
2nd line or for penicillin allergy → quadruple therapy
Quadruple therapy → bismuth subsalicylate 2 tabs qid or 30 ml Qid + metronidazole 500mg Qid + tetracycline 500mg Qid +ppi bid X 14 days
Post treatment: test of cure with breath test 30 days after treatment only if pt symptomatic or asymptomatic but complicated
What are the treatment options for quadruple therapy failure
1- ppl bid + amoxicillin + levofloxacin/ rifabutin
2- ppl + bismuth + tetracycline + clarithromycin
3 - PPi +bismuth+ levofloxacin + amoxicillin / metronidazole / tetracycline
Usual doses of psi used in H. Pylori eradication
Omeprazole 20mg, esomeprazole 20mg, rabeprazole 20mg, lansoprazole 30mg, pantoprazole 40 mg
Complications of H. Pylori infection
Non erosive gastritis ( 100% )
Peptic ulcer (15%)
Gastric adenocarcinoma (1%)
MALT lymphoma
Red flags for PUD
VBAD
Vomiting
Bleeding /anemia
Abdominal mass/ lymphadenopathy /unexplained weight loss > 10%
Dysphasia
Family Hx of gi cancer
Prev. Peptic ulcer
Post treatment for h-pylori
Asymptomatic and uncomplicated → no further management
Symptomatic or asymptomatic but complicated → urea breath test 30 days after treatment completion (needs to be off Abx for 30 days, off bismuth and PPI for 14 days and off antacids / H2 blockers for 24-48 hrs)
-Ve test → cure
+ test → 2nd line rx
Persistently + test after 2nd line → refer
