peptic ulcer diease Flashcards
what is PUD?
Erosion of the gastric mucosa by HCL and pepsin
can be acute or chronic
cause of PUD?
- idiopathic
- acid environment
- H pylori
- Nsaids, steroids
- o blood type
- smoking + etoh = contributing factors
what are the 2 types of ulcers
- gastric
- duodenal
- esophageal
how are gastric ulcers different to duodenal ulcers? what are clinical manifestations of pud?
gastric ulcers:
- food makes it worse
- wt loss
- d/t nsaid, incompetent pyloric sphincter
- vomiting blood
duodenal ulcers:
- food makes it better
- nocturnal pain
- dark tarry stools
- “burning” “cramp like” “gnawing”pain in mid-epigastric region
general symptoms:;
- anemia
- wt loss
- pyrosis
- sour taste in mouth
what is Zollinger-Ellison Syndrome?
tumor formation that causes increased release of gastrin which increases stomach acid production.
duodenal ulcels
what are dx test for PUD? what is the gold standard?
- Gastroscopy: GOLD STANDARD!! (EGD)
- urea breath test
- serum antibody lvls
- stool for occult blood
- CBC, LFT EST, CRP
- amylase, lipase/ latocse breath test
what are complications of PUD?
- haemorrhagic shock/ hypovolemic
- perforation -> ascites (severe abdo pain w blaoting,
fever, vomiting) - gastric outlet obstruction -> d/t scarring for
ulcerations - dumping syndrome (surgery)
emergencies that are treated conservatively and then lead to surgery
what are the types of bleeding?
1) hematemesis (bright red, coffee ground)
2) melena (black tarry, foul smelling)
3) occult
what medications are used to treat PUD?
- triple therapy (antibiotic + H2 blockers or PPI + antacid)
- PPI, H2 blockers, Cholinergic, Cytoprotective drugs, Antacids
what do H2 blcokers do? Example of med?
decreases HCL and pepsin
Avoid giving at the same time with antacids or Carafate. Instead give 30-45 minutes apart
drugs that end in tidine (ranitidine, pepcid)
what are proton pump inhibitors? example of med?
decrease release of gastric acids
(pantoloc, losec, prevacid)
what are cytoprotective drugs? example of meds?
lines the stomach and adheres to the ulcer site and protects it from acids and enzymes.
Take on empty stomach
don’t give at same time as antacids or H2 blockers
ex: sucralfate “carafate”
what are cholinergic drugs?
increase les pressure
ex: bethanechol
what are antacids? example?
neutralized stomach acid
interferes with MANY drugs: antibiotics, mucosal healing, H2 blockers so always
=> give alone + 1-2 hours before administering other medications
ex: magnesium prep, calcium carbonate
what are some lifestyle changes to prevent/decrease PUD?
- rest
- regular diet (small freq meals)
- cessation or reduction of smoking and alcohol
- stress reduction
- no nsaid unless rx by md
