Peptic Ulcer

Question 1

What is steps of an ulcer?

Answer 1

erosion, then acute ulcer, chronic ulcer

Question 2

What depth indicates ulcer?

Answer 2

> 5mm

Question 3

Common Causes of ulcers?

Answer 3

H pylori, NSAIDs, alcohol, smoking

Question 4

How does NSAIDs cause ulcers?

Answer 4

lower Cox 1= no prostaglandins which is protective
acid then irritates and makes it worse

Question 5

What are the lowest risk NSAIDs?

Answer 5

Celecoxib, ibuprofen

Question 6

Are we sure that celecoxib is the safest? When is it not?

Answer 6

> 6 month use, usinf with ASA, >400mg/day loses selectivity

Question 7

What puts people at risk of NSAID induced ulcers?

Answer 7

> 60, CVD, ASA, CS, anticoag, SSRI

Question 8

What type of bacteria is H pylori? Why is it bad for gi?

Answer 8

gram neg bacillus
makes ammonia= body cant tell how acidic stomach is, toxic
makes catalase, phospholipase to hide from immune

Question 9

Sx of ulcers?

Answer 9

mostly asymptomatic
dyspeptic sx

Question 10

If food helps dyspeptic pain what does this mean?

Answer 10

duodenal ulcer

Question 11

If food makes pain worse what does this mean?

Answer 11

gastric ulcer

Question 12

What is usual first sign of ulcer?

Answer 12

bleeding

Question 13

A patient that is know to have ulcers complains of tary stool. What do we tell them?

Answer 13

they have an ulcer in the upper and its bleeding

Question 14

A patient that is know to have ulcers complains of bright red blood in stool. What do we tell them?

Answer 14

MED EMERGENCY
hematochezia

Question 15

What can happen eventually with ulcers?

Answer 15

obstruction- due to scarring
perforation or fistula

Question 16

What would indicate that a perforation or fistula has occurred?

Answer 16

sudden change in sx
bad breathe

Question 17

A patient finds out they are colonized with H pylori. Will they get sx of ulcer

Answer 17

NOT necessarily

Question 18

When is H pylori testing indicated?

Answer 18

past PUD or active, past pylori, sx other than GERD or no NSAID

Question 19

How can we test for H pylori?

Answer 19

endoscopy, urea breath test= if radioactive CO2
stool antigen

Question 20

What increase recurrence rates of PUD?

Answer 20

NSAID, smoking, alcohol

Question 21

What is general treatment for ulcer?

Answer 21

stop NSAID if can
PPI
H2RA high dose
misoprostal

Question 22

When do you HAVE to stop NSAID for ulcer?

Answer 22

if bleeding is occurring in gi

Question 23

How long do you treat gastric ulcer and duodenal ulcer/

Answer 23

G= 8-12 weeks
D=4-8 weeks

Question 24

How can we prevent NSAID PUD?

Answer 24

lower dose, switch to celecoxib, add PPI, add misoprostol

Question 25

Rate the level of success of celocoxib/other NSAIDS with prevention meds?

Answer 25

Celecoxib/PPI>NSAID/PPI> Celecoxib mono>NSAID/Misoprostal> NSAID/H2RA

Question 26

How does misoprostol work?

Answer 26

prostaglandin analogue that increase mucous and bicarb

Question 27

WHy dont people use misoprostol?

Answer 27

4 x daily so bad adherence can cause dyspepsia interact with Mg

Question 28

What is first line treatment for H pylori? And when is one preferred over the other?

Answer 28

PBMT-pill burden, MOST efficacious PAMC-pen allergy!,clarithro bad, simpler

Question 29

WHy is metronidazole causes issues in treatment?

Answer 29

no alcohol, metallic taste

Question 30

What is the benefit of bismuth?

Answer 30

lowers resitance

Question 31

What is length of duration of therapy for H pylori?

Answer 31

14 days

Question 32

What are the second line therapy for H pylori?

Answer 32

PAC=better compliance, but bad PMC=better compliance, but bad PAM=better compliance, but bad PAL or PABL=bad, for treat failure PAR= better against resistance

Question 33

Why do we hate using PAR?

Answer 33

rifabutin is NECESSARY for TB

Question 34

Why isnt sequential therapy used?

Answer 34

high fail and complex

Question 35

If a patient is on anticoag or antiplatelet should you use bismuth?

Answer 35

risk of bleed theoretical

Question 36

What are issues with Bismuth (s/e)

Answer 36

darkening stool/tongue

Question 37

S/e of rifabutin?

Answer 37

urine discolor, myelotoxicity

Question 38

If you fail PAMC what is next step?

Answer 38

PAL then PBMT

Question 39

If you fail PBMT what is next step?

Answer 39

PAL then optimized PBMT

Question 40

Who should need confirmation of eradication of h pylori?

Answer 40

complicated duodenal ulcer, gastric ulcer

Question 41

What test for confirmation that pylori is gone?

Answer 41

fecal stool antigen four weeks after therapy

Question 42

How long should you continue PPI if duodenal ulcer vs gastric?

Answer 42

d= 2 weeks g=8 weeks

Question 43

Are probiotics helpful for H pylori?

Answer 43

not bad

Question 44

Is sucralfate helpful?

Answer 44

binds to ulcers and protects but not great agent