Peptic ulcer as an infectious disease Flashcards
where do peptic ulcers occur (3)
duodenal, antral, gastric body
T or F, prepyloric ulcers heal faster and are more likey to occur
false, heal slowly
whats the recurrence rate following ulcers that heal spontaneously
50-80%, in 6-12 months
state the recurrence rate if H pylori is treated
<10%
lifetime prevalence of PUD in pylori positive subjects
10-20%
lifetime prevalence of PUD in the general population
5-10%
what are the causes PUD (4)
1.H.pylori 2. NSAIDs 3. Smoking 4. extreme physiological stress
quantify the amount of ulcers that Hpylori is responsible for each duodenal or gastric ulcer
90% duodenal, 80% gastric
T or F, the majority of chldren are infected in developing nations
true usually before the age of 10, and 80% before the age of 50
which kind of lymphoma is associated with ulcers
MALT
what are the two mechanisms of h plyori attachment
1.formation of membrane attachments with host receptor proteins 2, binding of class II MCH inducing apoptosis
List the enzymes secreted by h.pylori
- urease 2. phopholipases 3. catalase 4. proteolytic
which enzymes degrades mucus
proteolytic
antioxidant that protects the bacteria from neutrophil toxic Oxygen.
catalase
alters the phospholipid content of the gastric mucosal barrier –> alters pH permeability
phospholipases
Direct effects or through binding to surface class II MHC inducing apoptosis
urease
which cells does the inflammatory response hail
b and t cells
list the genes that make a pt more suseptible to GUD
interluekin proteins, TNF alpha
state two causes of anemia in pts with ulcers
bleeding, decreased absorption
which of the following has both excellent sensitivity and specifificty _+ it is standardized a. culture b. rapid urease testing c. histology d. pcr
histology ©
which test has marginal sensititvity
culture
when is Culture ± PCR are recommended
Sx did NOT improve after initial Treatment
what is the gold standard
rapid urease testing
which test indicates active infection
urea breath test
which test is useful in monitoring treatment
urea breath test
list 4 reasons for false negative on urease test of the antral biopsu
a. Recent antibiotic use
b. GI bleeding
c. Use of Bismuth compound
d. Use of Proton pump inhibitors
which two drugs should be stopped 2 weeks before biopsy
bismuth and ppi
which drug should be stopped 4 weeks before biopsy
antibiotics
regimin 1
clarithromycin, amoxicillin, ppi for two weeks followed by ppi for 2 weeks
regimin 2
clarithromycin, metronaidazole, ppi fort wo weeks followed by ppi for 2 weeks
regimin 3
metronidazole, tetracycline, bismuth subsalicylate, h2 receptor ntagonist for 2 weeks follow by h2 receptor anatagonist for 2 weeks
which regimin can’t be used in children and why
regimin 2, bec of tretracycline/doxyclinicine
when is regimin 2 indicated
pts allergic to penicillin
Failure of eradication rate
20%
state 4 indications for confirming the eradication of ulcers
· Persistent symptoms after treatment for dyspepsia · H. pylori associated ulcer
· Lymphoid tissue (MALT) lymphoma
· Resection for early gastric cancer
mention 2 tests that can identify antibiotic susceptibility
culture and pcr but pcr isn’t sensitive thus is used when pt is treated empirically
whats the most common cause of refractory ulcers
medication noncomplicancce
gastric ulcers most commonoly penetrate into
left lobe of the liver
duodenal ulcers most commonly penetrate into the
posteriroly to the adjacent pancreas
whats the best endoscopic test done
urease
whats the best nonendoscopic test done
urease breath test
