part 7

Question 1

What are the diagnostic studies for PUD?

Answer 1

• endoscopy: most accurate
• barium contrast
• Labs: CBC (anemia due to ulcer bleeding), liver enzymes, serum amylase (if ulcer is effecting pancreas)
• stool tested for blood
• urea breath test

Question 2

Explain patho of PUD?

Answer 2

• breakdown of gastric mucosal barrier
• destruction of mucosal cells
• histamine release increases acid and pepsin release
• leads to ulceration

Question 3

gastric ulcers can be found anywhere in the stomach but where are they most commonly found?

Answer 3

-mostly found in the antrum

Question 4

What type of ulcer is more likely to result in hemorrhage, perforation, and obstruction

Answer 4

gastric ulcers

Question 5

• this type of ulcer can occur at any age
• increased between 35-45
• account for 80% of all peptic ulcers
• H. pylori is found in 90-95% of patients
• associated with increased HCL secretion
• alcohol and smoking are associated

Answer 5

duodenal ulcers

Question 6

People with what conditions have an increased risk of duodenal ulcers?

Answer 6

COPD 
Cirrhosis of liver 
chronic pancreatitis 
hyperparathyroidism 
chronic kidney disease 
zollinger ellison syndrome

Question 7

pain high in epigastrium
1-2 hours post meal
burning and gaseous
food aggravates if ulcer has eroded through gastric mucosa

Answer 7

gastric ulcers

Question 8

pain midepigastric region beneath xiphoid process
back pain possibly
pain 2-5 hours post meal
burning or cramp like
will occur then disappear then occur again (months in-between flare up)

Answer 8

duodenal ulcer pain

Question 9

What are 3 major complications of PUD?

Answer 9

hemorrhage (most common)
perforation (pain spreads throughout abd)
gastric outlet obstruction (projectile vomiting common)
-all emergency situations
-may require surgery

Question 10

• abdomen is rigid and boardlike
• respirations are shallow and rapid
• heart rate is elevated
• pulse is weak
• bowel sounds absent
• N/V

Answer 10

perforation due to PUD

Question 11

What is the treatment of PUD?

Answer 11

• dietary and lifestyle: healthy foods that don’t trigger, no alcohol or smoking
• Meds
• Surgical

Question 12

What are the surgical procedures for PUD?

Answer 12

• perforation: simle closure with momentum graft
• vagotomy: severing the vagus nerve to decrease gastric acid secretion
• ulcer removal: billroth I and II