General Surgery/GIT / Peptic Ulcer Disease Flashcards
What are the two major etiologies of peptic ulcer disease (PUD)?
- Helicobacter pylori (H. pylori) infection
- Nonsteroidal anti-inflammatory drug (NSAID) use
What symptoms do patients with PUD have?
Epigastric pain of a burning or gnawing quality that may radiate to the back
Pain that is relieved by food intake or antacids, but recurs 2-3 hours after meals and during the night on an empty stomach is classic for what diagnosis?
Duodenal ulcer
Pain that occurs very soon after meals and is less responsive to antacids is classic for what diagnosis?
Gastric ulcer
What are the complications of peptic ulcers?
- perforation
- penetration
- hemorrhage
- pyloric outlet obstruction
What is the differential diagnosis of PUD?
- nonulcer dyspepsia (functional dyspepsia)
- drug-induced dyspepsia
- gastric carcinoma
- duodenal neoplasia
- Crohn disease
- granulomatous disease
- gastric infections
- duodenal infections
How is PUD diagnosed?
The clinical history raises suspicion for PUD, and confirmation can be made by upper endoscopy or a radiographic upper gastrointestinal (GI) series.
How is a peptic ulcer diagnosed by upper GI series?
Barium in a round or oval ulcer crater
If an upper GI series shows an ulcer within a mass protruding into the gastric lumen, an irregular filling defect in the ulcer crater and irregularity of the mucosal folds, what should you be concerned about?
Gastric cancer
H. pylori infection increases the risk of what malignancies?
- gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma, which frequently regresses with H. pylori eradication
What noninvasive tests are available to test patients for H. pylori infection?
- Serum H. pylori IgG antibody serology (stays positive even after treatment)
- carbon-labeled urea breath testing
- stool antigen testing
How is H. pylori infection eradicated?
- PPI for acid suppression and
- Antibiotics twice daily for 10-14 days
- clarithromycin and amoxicillin or metronidazole
When should PUD be managed surgically?
- peptic ulcers refractory to medical therapy
- recurrent peptic ulcers
- ulcer disease that is complicated by hemorrhage, penetration, perforation, or obstruction
- duodenal ulcers greater than 5 cm in size
What is the basic goal of peptic ulcer surgery?
- Selective vagotomy to denervate the acid-secreting parietal cells of the stomach
What is Zollinger-Ellison syndrome?
Hypersecretion of gastric acid caused by a gastrin-secreting islet cell tumor of the pancreas, resulting in multiple peptic ulcers that may be in unusual locations and are refractory to standard medical treatment or recurrent after surgery
