High-Yield Concepts in Peptic Ulcer Disease (Gastrointestinal Diseases)

Question 1

Key enzyme in rate-limiting step of prostaglandin synthesis

Answer 1

Cyclooxygenase (COX)

Question 2

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

Answer 2

H. 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 (between midnight and 3 AM)

Question 5

Most frequent findings in patients with GU/DU

Answer 5

Epigastric tenderness

Question 6

PUD-related complications

Answer 6

GI bleeding > perforation > gastric outlet obstruction (in order of decreasing frequency)

Question 7

Most potent acid inhibitory agents

Answer 7

Proton Pump Inhibitors (PPIs)

Question 8

Most common toxicity with Sucralfate

Answer 8

Constipation

Question 9

Most common toxicity with Prostaglandin Analogues

Answer 9

Diarrhea

Question 10

Most feared complication with Amoxicillin, Clindamycin

Answer 10

Pseudomembraneous colitis (treat with oral vancomycin or IV metronidazole)

Question 11

Refractory Peptic Ulcers

Answer 11

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

Question 12

Most common cause of treatment failure in compliant patients

Answer 12

Antibiotic-resistant H. pylori stains

Question 13

Test of choice for documenting eradiccation of H. pylori

Answer 13

Urea breath test (UBT)

Question 14

Most commonly performed operations for DUs

Answer 14

Vagotomy and drainage
Highly selective vagotomy
Vagotomy with antrectomy

Question 15

High ulcer recurrence rate, but lowest complication rate

Answer 15

Highly Selective Vagotomy

Question 16

Lowest ulcer recurrence rate, but highest complication rate

Answer 16

Vagotomy with Antrectomy

Question 17

Surgery of choice for an Antral Ulcer

Answer 17

Antrectomy (including the ulcer) with a Billroth I anastomosis

Question 18

Cornerstone of therapy for Dumping Syndrome (DS)

Answer 18

Dietary modification

Question 19

Severe peptic ulcer diathesis secondary to gastric acid hypersecretion due to unregulated gastrin releease from gastrinomas

Answer 19

Zollinger-Ellison Syndrome (ZES)

Question 20

Most common location of Gastrinomas

Answer 20

Pancreas&raquo_space; duodenum

Question 21

Gastrinoma Triangle (contains over 80% of these tumors)

Answer 21

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

Question 22

Most common clinical manifestations of Gastrinoma

Answer 22

Peptic ulcer, followed by diarrhea

Question 23

First step in the evaluation of Gastrinoma

Answer 23

Obtain a fasting gastrin level

Question 24

Most sensitive/specific Gastrin Provocative Test

Answer 24

Secretin study

Question 25

Treatment of choice for Gastrinoma

Answer 25

PPIs

Question 26

Most common presentation of Stress-Related Mucosal Injury (SRMI)

Answer 26

GI bleeding

Question 27

Treatment of choice for Stress Prophylaxis

Answer 27

PPIs (preferably oral if tolerated)

Question 28

Most common causes of Acute Gastritis

Answer 28

Infectious

Question 29

Important predisposing factor for Gastric Cancer

Answer 29

Intestinal metaplasia

Question 30

Type A Gastritis (“Autoimmune”: anti-parietal cell antibodies)

Answer 30

Involves primarily the fundus and body, with antral sparing

Less common type

Question 31

Type B Gastritis (“Bacteria”: H. pylori-associated)

Answer 31

Antral-predominant

More common type

Question 32

Menetrier’s Disease

Answer 32

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