Gastro-Peptic ulcer disease

Question 1

Key enzyme in rate-limiting step of prostaglandin synthesis

Answer 1

Cyclooxygenase

Question 2

Most common cause of gastric/duodenal ulcers(GU/DU)

Answer 2

Helicobacter pylori and NSAIDs

Question 3

Most common location of DUs

Answer 3

1st portion of the duodenum

Question 4

Most discriminating symptom of DUs

Answer 4

Pain that awakens the patient from sleep

Question 5

PUD-related complications

Answer 5

GI bleeding>perforation>obstruction

Question 6

Most potent acid inhibitory agents

Answer 6

Proton pump inhibitors (PPIs)

Question 7

Refractory peptic ulcers

Answer 7

GU: failure to heal after 12 weeks of therapy
DU: failure to heal after 8 weeks of therapy

Question 8

Most common cause of treatment failure in compliant patients

Answer 8

Antibiotic resistant H.pylori strains

Question 9

Most commonly performed operations for DUs

Answer 9

Vagotomy and drainage
Highly selective vagotomy
Vagotomy with antrectomy

Question 10

High ulcer recurrence rate, but lowest complication rate

Answer 10

Highly selective vagotomy

Question 11

Lowest ulcer recurrence rate, but highest complication rate

Answer 11

Vagotomy with antrectomy

Question 12

Surgery of choice for an antral ulcer

Answer 12

Antrectomy(including the ulcer) with Billroth I anastomosis

Question 13

Severe peptic ulcer diasthesis secondary to gastric acid hypersensitivity due to unregulated gastrin release from gastrinomas

Answer 13

Zollinger-Ellison syndrome

Question 14

Most common location of gastrinomas

Answer 14

Pancrease&raquo_space; duodenum

Question 15

Gastric triangle (contains 80% of these tumors)

Answer 15

Superior border: cystic and common bile ducts
Inferior border: junction of the 2nd and 3rd portions of the duodenum
Medial border: junction pf the neck and body of pancreas

Question 16

Most common clinical manifestation of gastrinoma

Answer 16

Peptic ulcer followed by diarrhea

Question 17

First step in the evaluation of gastrinoma

Answer 17

Obtain a fasting gastrin level

Question 18

Most common presentation of stress-related mucosal injury(SRMI)

Answer 18

GI bleeding

Question 19

Treatment of choice for stress prophylaxis

Answer 19

PPIs(preferably oral if tolerated)

Question 20

Most common cause of acute gastritis

Answer 20

Infectious

Question 21

Type A gastritis(Auto-immune: anti-parietal cell antibodies)

Answer 21

Involves primarily the fundus and body, with antral sparing

Less common type

Question 22

Type B gastritis (Bacteria: H.pylori-associated)

Answer 22

Antral-predominant

More common type

Question 23

Menetrier’s disease

Answer 23

Large, tortuous gastric mucosal folds(not a form of gastritis)