High-Yield Concepts in Peptic Ulcer Disease (Gastrointestinal Diseases) Flashcards
Key enzyme in rate-limiting step of prostaglandin synthesis
Cyclooxygenase (COX)
Most common causes of gastric/duodenal ulcers (GU/DU)
H. pylori and NSAIDs
Most common location of DUs
1st portion of the duodenum
Most discriminating symptom of DUs
Pain that awakens the patient from sleep (between midnight and 3 AM)
Most frequent findings in patients with GU/DU
Epigastric tenderness
PUD-related complications
GI bleeding > perforation > gastric outlet obstruction (in order of decreasing frequency)
Most potent acid inhibitory agents
Proton Pump Inhibitors (PPIs)
Most common toxicity with Sucralfate
Constipation
Most common toxicity with Prostaglandin Analogues
Diarrhea
Most feared complication with Amoxicillin, Clindamycin
Pseudomembraneous colitis (treat with oral vancomycin or IV metronidazole)
Refractory Peptic Ulcers
GU: failure to heal after 12 weeks of therapy
DU: failure to heal after 8 weeks of therapy
Most common cause of treatment failure in compliant patients
Antibiotic-resistant H. pylori stains
Test of choice for documenting eradiccation of H. pylori
Urea breath test (UBT)
Most commonly performed operations for DUs
Vagotomy and drainage
Highly selective vagotomy
Vagotomy with antrectomy
High ulcer recurrence rate, but lowest complication rate
Highly Selective Vagotomy
Lowest ulcer recurrence rate, but highest complication rate
Vagotomy with Antrectomy
Surgery of choice for an Antral Ulcer
Antrectomy (including the ulcer) with a Billroth I anastomosis
Cornerstone of therapy for Dumping Syndrome (DS)
Dietary modification
Severe peptic ulcer diathesis secondary to gastric acid hypersecretion due to unregulated gastrin releease from gastrinomas
Zollinger-Ellison Syndrome (ZES)
Most common location of Gastrinomas
Pancreas»_space; duodenum
Gastrinoma Triangle (contains over 80% of these tumors)
Superior border: cystic and commpn bile ducts
Inferior border: junction of the 2nd and 3rd portions of the duodenum
Medial border: junction of neck and body of pancreas
Most common clinical manifestations of Gastrinoma
Peptic ulcer, followed by diarrhea
First step in the evaluation of Gastrinoma
Obtain a fasting gastrin level
Most sensitive/specific Gastrin Provocative Test
Secretin study
Treatment of choice for Gastrinoma
PPIs
Most common presentation of Stress-Related Mucosal Injury (SRMI)
GI bleeding
Treatment of choice for Stress Prophylaxis
PPIs (preferably oral if tolerated)
Most common causes of Acute Gastritis
Infectious
Important predisposing factor for Gastric Cancer
Intestinal metaplasia
Type A Gastritis (“Autoimmune”: anti-parietal cell antibodies)
Involves primarily the fundus and body, with antral sparing
Less common type
Type B Gastritis (“Bacteria”: H. pylori-associated)
Antral-predominant
More common type
Menetrier’s Disease
Large, tortuous gastric mucosal folds (not a form of gastritis)
