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Y3R5: Medicine I 🩺 > L14: Peptic Ulcer > Flashcards

L14: Peptic Ulcer Flashcards

1
Q

Def of Peptic Ulcer

A

Defect in the gastrointestinal mucosa that extend through the muscularis mucosa ( > 5 mm)

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2
Q

Sites of Peptic Ulcer

A
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3
Q

Pathophysiology of Peptic Ulcer

A

Peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms
is disrupted

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4
Q

Etiology of Peptic Ulcer

A
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5
Q

Characters of H.Pylori

A
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6
Q

Peptic ulcer may be associated with (4Cs)

A

Cigarette smoking, Cirrhosis of liver,
COPD, and Chronic renal failure

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7
Q

CP of Peptic ulcer

A
  • Asymptomatic
  • Symptomatic
  • Complications
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8
Q

Asymptomatic Peptic ulcer

A

Approximately 70% of peptic ulcers are asymptomatic.

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9
Q

Symptoms of Peptic ulcer

A
  • Epigastric pain/ Dyspepsia
  • anorexia
  • nausea
  • vomiting.
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10
Q

Characters of Epigastric pain of PU

A

burning, gnawing or dull ache

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11
Q

Sites of Epigastric pain of PU

A
  • DU : above the umbilicus & to the right of the midline.
  • GU : epigastric & in the midline
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12
Q

Duration of Epigastric pain of PU

A

variable from few minutes to several hours.

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13
Q

Relation of Epigastric pain of PU to food

A
  • DU : 2 - 3 h after meals (usually awakens the patient)
  • GU : precipitated by food ½ h after meals
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14
Q

Relieving factors of Epigastric pain of PU

A
  • DU : antacid or food , so appetite ↑ ( patient eats frequently to relief pain)
  • GU : fasting , vomiting ( some patients learn to induce vomiting for pain relief )
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15
Q

Complications of Peptic Ulcer

A
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16
Q

Investigations in Peptic Ulcer

A

I. Upper GI endoscopy (Diagnostic)
II. Investigations for the cause
III. Investigations for complications

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17
Q

Upper GI Endoscopy in Peptic Ulcer

A

The gold standard in diagnosing PUD

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18
Q

When to Bx a Peptic Ulcer?

A
  • DU are mostly benign, do not require biopsy except in the setting of Crohn’s disease.
  • DU patients should have antral biopsy to diagnose H pylori.
  • GU patients over 40 years should have biopsy to exclude gastric cancer.
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19
Q

Investigations for the cause in PU

A
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20
Q

Investigations for complications in PU

A
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21
Q

Lab Findings in PU

22
Q

Imaging in PU

23
Q

DDx of PU

24
Q

Managment of PU

A

I. Treat the underlying etiology
II. Antisecretory therapy
III. Other general measures
IV. Management of complication

25
Q

TTT of underlying cause in PU

A

1) Eradication of H. pylori
2) Discontinue NSAIDs

  • In patients with PUD of unclear etiology, additional evaluation is needed to exclude other rare causes
26
Q

Eradication of H.Pylori

27
Q

Types of Antisecretory therapy

A
  • PPIs
  • H2RAs
  • Antacids
  • Sucralfate
28
Q

Significance of PPIs in PU

A

First-line antisecretory therapy in the treatment of PUD.

29
Q

MOA of Proton pump inhibitors (PPIs)

A

Irreversible inhibitor of H+ K+ ATPase

30
Q

Nature of Proton pump inhibitors (PPIs)

A

Prodrugs requiring activation in acid environment

31
Q

Timimg of Proton pump inhibitors (PPIs)

A

Administered 30 to 60 minutes before breakfast for maximal inhibition of proton pumps

32
Q

Examples of Proton pump inhibitors (PPIs)

A

 Omeprazole  Pantoprazole
 Lansoprazole  Rabeprazole
 Esomeprazole

33
Q

Duration of Proton pump inhibitors (PPIs)

A

 DU : 4 weeks
 GU : 8 weeks

34
Q

MOA of Histamine-2 receptor antagonists (H2RAs)

A

Reversible competitive inhibitors of H2 receptor on the parietal cell.

35
Q

Selectivity of Histamine-2 receptor antagonists (H2RAs)

A

Highly selective, No action on H1 or H3 receptors.

36
Q

Histamine-2 receptor antagonists (H2RAs) & Nocturnal acid secretion

A

Effective in inhibiting nocturnal acid secretion

37
Q

Examples of Histamine-2 receptor antagonists (H2RAs)

A

Cimetidine, Famotidine, Nizatidine

38
Q

SE of Cimtidine

A
  • May cause gynecomastia, galactorrhea
  • Inhibits CYP450 & may increase conc. Of Warfarin, Theophylline, Phenytoin
39
Q

Ranitidine Withdrawn by FDA due to Contamination with ……

A

nitrosodimethylamine (NDMA)

40
Q

Composition of Antacids

A

Usually contain a combination of magnesium trisilicate, aluminum hydroxide, or calcium carbonate

41
Q

MOA of Antacids

A

Antacids can neutralize gastric acid and reduce
acid delivery to the duodenum

42
Q

Comnposition of Sucralfate

A

Salt of sucrose complexed to sulfated
aluminium hydroxide

43
Q

MOA of Sucralfate

A

In acidic pH polymerises to viscous gel that adheres to ulcer crater

44
Q

Timing of Sucralfate

A

Taken on empty stomach 1 hr. before meals

45
Q

Although Antacids and Sucralfate can heal duodenal ulcers, they are ……

A

not routinely recommended to treat peptic ulcers as PPIs heal ulcers more rapidly and to a greater extent.

46
Q

What are other general Measures in PU?

A

 Avoid tobacco
 Avoid alcohol
 Avoid hot, spicy, and greasy foods
 Weight loss
 Do not eat before bed

47
Q

Managment of Complications in PU

48
Q

Managment of Bleeding PU

49
Q

Managment of Gastric outlet obstruction in PU

50
Q

Managment of Perforated PU

51
Q

Done

Y3R5: Medicine I 🩺 (47 decks)

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