Peptic Disease/Gastritis Flashcards

1
Q

Ranitidine= H2 antagonist

A

Note that there is much more H. pylori in eastern europe

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2
Q

What is the Ddx?

A
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3
Q

What is a peptic ulcer?

A

A discontinuity that occurs in the Gi epithelium that is exposed to acid and pepsin, most commonly in the stomach or duodenum

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4
Q

T or F. You cannot distinguish a gastric from duodenal peptic ulcer based on the pts. symptoms

A

T.

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5
Q

What parts of this mans Hx favor peptic ulcer over functional dyspepsia?

A
  • localized pain to the epigastrium
  • waking the pt. at night
  • helps by eating (pain with functional dyspepsia usually get worse with eating)
  • helps with acid suppressing meds. (also true of functional dyspepsia)
  • the intermittent nature of the pain (chronic, every-day pain would be highly uncharacteristic of peptic ulcer)
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6
Q

T or F. The pain of peptic ulcer typically waxes and wanes

A

T. Not constant like in functional dyspepsia

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7
Q
A
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8
Q

Functional dyspepsia is much more common today!

A
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9
Q

What is ‘dyspepsia’?

A

really more of a symptom than a diagnosis- can be interchanged with indigestion, but it is a localized pain/burning in the upper abdomen

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10
Q

T or F. With a diagnosis of functional dyspepsia, the normal anatomy of the GI will be normal and functioning properly

A

T. It is more idiopathic

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11
Q

Want to know about OTC pain meds

Being from eastern europe (and east asia, south america)= H. pylori risk

A
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12
Q
A

Endoscopy too expensive

Barium X-ray pretty hardcore- endoscopy better

Gall bladder might be bad

H. pylori can be checked at the time of endoscopy or via blood draw

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13
Q

Youre not expecting to feel a peptic ulcer on abdominal exam

Pointing sign= can the pt. point to the source of pain with 1 finger. If they can, increased likelihood of peptic ulcer

A

Note that a positive test for H. pylori means hes been infected at some pt. and he may/may not still have it.

Most H. pylori infections are acquired pediatrically (first 6-7 yrs of life) and highly unlikely to be acquired after. These infections manifest during adulthood, however.

Children can clear the infection on their own and get re-infected but adults cannot clear the infection alone despite the presence of an immune response

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14
Q

How does H. pylori spread?

A
  • fecal-oral spread
  • gastric-oral spread
  • mother-child via close contact
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15
Q

Note that for Americans, the incidence of H. pylori infection has continually dropped so that most positive pts. will be older

A
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16
Q

Endoscopy of pt. 1

A
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17
Q

the tx of an ulcer depends on whethers its H. pylori + or -

A

Note that H. pylori is the cause of roughly 60-70% of duodenal ulcers and

you cant tell whether its H. pylori positive or negative just by looking a the ulcer via endocopy OR by biopsy

18
Q

Need an ANTRAL biopsy. The neutrophils have to be in the glands!!!

If you have either active (neutrophils) or chronic (lymphocytic) inflammation, look for H. pylori!

A

Must get a biopsy of the antrum and like to live in the crypts- described as seagulls. Can also do silver stains or IHC (right- black things)

19
Q

there there is no inflammation but the crypts become very squiggly and elongated in reactive/chemical gastropathy

A
20
Q

H. pylori will not be found in intestinal metaplasia (notice the goblet cells).. it needs normal gastric epithelium

A
21
Q

These pts. have an icnreased risk of LYMPHOMA due to the presence of MALT tissue (note that this is kind of a fake lymphoma in that it is a monoclonal proliferation of cells but if you treat the H. pylori a lot of pts, will get better)

Notice that HP is brown on IHC

A
22
Q
A
23
Q

Note that if a population of B cells in the GI express BOTH CD20 and CD43, it is a lymphoma

A
24
Q

Note that pts. should never be given the diagnosis of gastritis.. that is a histological finding and doesnt describe any clinical or endoscopic abnormality

A
25
Q

Note that duodenal ulcers are almost (99+%) NEVER malignant (so dont biopsy typically), while gstric ulcers are more likely and warrant a biopsy. You are NOT going to find H. pylori anywhere but the stomach

A

Definitely treat the infection

26
Q

T or F. ALL peptic ulcer pts. MUST be tested for H. pylori and all who have it MUST be treated for it

A

T.

27
Q

Despite feeling better, you MUST complete the full 14 days

A
28
Q
A
29
Q

Only need to recheck endoscopy to make sure if it healed if it was a gastric ulcer, but not a duodenal ulcer (duodenal malignancies very rare)

You do want to confirm eradication of H. pylori infection (only about 70% will clear with ABX)

A

NEVER do serology in a pt. after tx for H. pylori- pts. may remain positive for yrs. even after clearing

30
Q

The negative breath test does mean he’s cured

chances of re-infection are less than 1%/yr in adults (more likely in children)

A
31
Q

Note that H. pylori clarithromycin resistance is a big problem

A
32
Q

H. pylori has urease activity! It will split the urea to ammonia and Co2 to be breathed out

Notice the causes of false-negatives

A
33
Q
A
34
Q
A
35
Q

Probably has an upper GI bleed

the black, tarry stool comes from melana (means ‘black’)

A
36
Q
A
37
Q

Dont want to biopsy the ulcer for risk of further bleed (might be okay if she hadnt bled before)

A

H. pylori serology has a very good NEGATIVE predictive value (but not good positive predictiveness)

38
Q

The process of NSAID induced damage is typically painless.. especially in older pts.

A
39
Q
A

Yes it is right to restart aspirin therapy

dont restart diclofenac, switch to the safer celecoxib

She definitiely needs to be on a PPI for the rest of her life if shes gonna stay on aspirin

She does need another EGD

40
Q
A

Remember that peptic uclers can have no Hx of pain especially in older pts and those taking NSAIDs!!