OnlineMedEd: Gastroenterology - "Peptic Ulcer"

Question 1

_________ ulcers are usually associated with H. pylori. _________ ulcers are almost always associated with H. pylori.

Answer 1

Gastric; duodenal

Question 2

List the six etiologies of peptic ulcers.

Answer 2

• H. pylori
• NSAIDs
• Malignancy
• Cushing
• Curling
• Gastrinoma

Question 3

Go through how relation to food can help you narrow down the location of the ulcer.

Answer 3

• Worse with food: gastric (because the stomach secretes acid in response to eating)
• Better with food: duodenal (because the duodenum secretes bicarb with food)

Question 4

Talk about how the appearance of the ulcer can correlate with the kind.

Answer 4

• Multiple, shallow ulcers: NSAIDs

* Deep, heaped-up ulcer: malignancy

Question 5

Cushing ulcers present in those with head injuries and _________________.

Answer 5

those on ventilators; the alkalotic state can induce increased intracranial pressure which triggers activation of the vagal nerve which stimulates acid secretion

Question 6

What three modifiable factors can cause ulcers?

Answer 6

• Smoking
• Drinking
• NSAIDs

Question 7

What drugs are used for treatment and prophylaxis of ulcers?

Answer 7

• Treatment: high-dose PPIs

* Prophylaxis: low-doe PPIs

Question 8

Those with PUD present with what symptoms?

Answer 8

• Asymptomatic: 20%

* Gnawing epigastric pain in relation to food

Question 9

Go through the diagnostic and treatment scheme for PUD.

Answer 9

• First, do endoscopy if they have s/s worrisome for PUD.
• If they have a history of NSAID use and the ulcers look like NSAID ulcers, then have them stop NSAIDs and take a PPI.
• If it looks like a malignant ulcer or an ulcer suspicious for H. pylori, then take a biopsy and treat according to result.

Question 10

How likely is it that H. pylori will cause an ulcer?

Answer 10

Only about 15% of those infected will develop an ulcer.

Note: of the remaining 15%, about 13.5% has dyspepsia and ulcer and the other 1.5% has a maltoma.

Question 11

Beyond endoscopy with biopsy, what is a better test: histology or culture?

Answer 11

Histology

Question 12

Stool antigen for H. pylori is useful for ____________.

Answer 12

monitoring eradication

Question 13

How is serology helpful?

Answer 13

In low-resource settings, a positive serology in the setting of dyspepsia is a reasonable treatment paradigm (even though serology will be positive in cleared infections).

Question 14

List the triple therapy.

Answer 14

• Clarithromycin
• Amoxicillin
• PPI

Question 15

Gastrinomas have what eponym?

Answer 15

Zollinger-Ellison syndrome

Question 16

How do those with Zollinger-Ellison syndrome present?

Answer 16

Multiple large ulcers that are refractory to PPIs

Question 17

How can you finally diagnose a gastrinoma?

Answer 17

Test the serum gastrin level. It should be less than 250. If it’s greater than 1600, then it’s a gastrinoma.

Question 18

In those with Zollinger-Ellison, it’s important to check ______________ as a follow-up.

Answer 18

for gastric malignancy