peptic ulcer

Question 1

risk factors for peptic ulcers?

Answer 1

h pylori infection, chronic nsaid use, smoking, caffiene, alcohol, zollinger ellison syndrome

Question 2

symptoms of peptic ulcers? gastric vs duodenal?

Answer 2

shared symptoms: burning epigastric pain, GERD, N/V, dyspepsia (postprandial heaviness, early satiety), bloating, potential upper GI bleeding, stool occult blood positive

gastric: pain occurs shortly after eating (secretion of acid)
duodenal: pain relieved shortly after eating (acid is buffered) and increases at night (woken up from sleep)

Question 3

diagnosis? including red flags?

Answer 3

-CBC (anemia), stool occult blood test (could be positive), h pylori test (urea breath test/stool antigen test)

for patients with red flags for dyspepsia (old, family hx for gi cancer, weight loss, GI bleeding and anemia, dysphagia/odynophagia): do endoscopy with biopsies

if suspecting ZE: fasting serum gastrin levels, secretin stimulation test, endoscopy

Question 4

where and how many biopsies to take?

Answer 4

from the edge and base of the ulcer. multiple biopsies from different areas

Question 5

medical treatment for PUD?

Answer 5

lifestyle change: stop caffeine, alcohol, nsaid

start with PPI for 4-8 weeks/H2 antagonists (ranitidine)/ antacids

if h pylori positive: triple therapy with PPI, amoxicillin and clarithromycin
or quadruple therapy (PPI, metronidazole, tetracycline, bismuth) if patient failed the triple

Question 6

indications and name of surgical procedure? with complication?

Answer 6

indicated after failure of medical treatment

do vagotomy (division of anterior and posterior vagal trunk of vagus nerve)
complications: delayed gastric emptying and diarrhea

billroth: partial gastrectomy

Question 7

complications of PUD?

Answer 7

bleeding, perforation, fistula, gastric outlet obstruction