Peptic Ulcer Disease

Question 1

What are the two biggest stimulants for Gastrin secretion?

Answer 1

1. Luminal proteins in the stomach

2. Gastrin Releasing Peptide (GRP)

Question 2

What are the 3 things that stimulate acid secretion from gastric parietal cells.

Answer 2

1. Histamine
2. Gastrin
3. ACh

Question 3

What is Zollinger-Ellison syndrome?

Answer 3

One of the Multiple Endocrine Neoplasms (MEN) Type 1 that involves a Gastrin secreting tumor in pancreatic islet cells

Question 4

What are the 3 classifications of Gastritis and examples of each?

Answer 4

1. Erosive Hemorrhagic: stress or ICU induced, NSAID induced, reflux injury
2. Non-erosive Non-specific: H. pylori, autoimmune, cancer
3. Specific: micro infections

Question 5

What is the etiology, diagnosis, and treatment for Type A vs. Type B gastritis?

Answer 5

Type A:

1. Autoimmune
2. Achlorohydria
3. Life-long IV Vit. B 12

Type B

1. H. Pylori
2. Urea breath test
3. if required, PPI w/ antibiotics

Question 6

What is the final clinical manifestation of Chronic Atrophic Gastritis?

Answer 6

Pernicious anemia, pts. need parenteral Vit. B12

Question 7

What are the 3 main etiologies of Peptic Ulcers?

Answer 7

1. H. Pylori
2. NSAID abuse
3. Stress

Question 8

What are the 4 biggest risk factors for PUDs?

Answer 8

1. Smoking
2. Alcohol
3. Adrenocorticosteroid use longer than 1 week
4. NSAID use

Question 9

Most sensitive test to detect PUD.

Answer 9

Endoscopy (95%)

-h&p along with upper GI radiology is also useful

Question 10

What is the biggest contraindication for using PG analogs to treat PUD?

Answer 10

PGs cause smooth muscle contraction and could cause spontaneous abortion in pregnant patients.

Question 11

What is the management strategy for peptic ulcers?

Answer 11

Duodenal ulcers: either PPI, sucralfate, or H2RAs for 4-8 weeks. Antibiotics if H. pylori is present.

Stomach ulcers: the same except for a repeat endoscopy is performed to check for malignancy.

Question 12

What 3 things should be considered if a patient has a non-healing ulcer?

Answer 12

1. ZE syndrome
2. Smoker
3. NSAID use

Question 13

What is the treatment for a bleeding ulcer?

Answer 13

Contact thermal probe with endoscopy.

NO PHARM THERAPY CAN STOP AN ULCER BLEED!!!!
-some can only prevent it

Question 14

What is the treatment for an ulcer caused by a gastric obstruction?

Answer 14

Continuous IV PPI with surgical pyloroplasty or endoscopic balloon.

Question 15

Type of gastritis associated with H. pylori

Answer 15

Type B

Question 16

Excluding NSAID abuse and ZE syndrome, what is 99.9% associated with duodenal ulcers?

Answer 16

H. pylori infection

-not all people with this infection develop duodenal ulcers

Question 17

What is dyspepsia?

Answer 17

Indigestion, recurrent pain in the upper abdomen.

Question 18

What are management recommendations for patients that have Non-Ulcer Dyspepsia?

Answer 18

Younger than 55: test and treat approach, PPI trial

Older than 55 or w/ alarming symptoms: endoscopic exam and treatment based on these findings

Question 19

What are the three best tests to diagnose and monitor H. pylori infection?

Answer 19

1. Gastric Biopsy (gold standard)
2. Carbon-urea breath test (most commonly used to test if treatment worked)
3. Stool or Urine antigen test (good for documenting eradication 4 weeks post treatment)

Question 20

Which group of people infected with H. pylori is most crucial to treat?

Answer 20

Patients with a past history of gastric MALT lymphoma. (MOST IMPORTANT)

Patients with current stomach or duodenal ulcers or patients with past history of complications should also be treated.

Question 21

What is the standard treatment for H. pylori infection?

Answer 21

PPI/amoxicillin/clarithromycin

10-14 day

Question 22

What is Menetrier disease and how is it treated?

Answer 22

Hypertrophic gastric folds of unknown etiology.

Treat with PPI, H2RA, and prednisolone

Question 23

What is eosinophilic gastritis and how is it treated?

Answer 23

Inflammation of gastric mucosa most likely caused by an allergic reaction.

Treatment is prednisolone steroids to suppress the immune system.

Question 24

What are gastric bezoars?

Answer 24

A type of solid mass or concretion of foreign matter that becomes lodged in the stomach.

Question 25

What predisposes people to bezoars?

Answer 25

Any compromise of gastric motility; previous gastric surgery, PUD, crohn disease, cancer

MOST COMMON cause is gastric stasis due to diabetic neuropathy

Question 26

What is the main cause of volvulus and the two types?

Answer 26

Caused by laxity in suspensory ligaments.
1. Organo-axial: rotation around a line thru the pyloric sphincter and gastro-esophageal junction.

2. Mesentro-axial: rotation around a horizontal line running thru the greater curvature and porta hepatis

Question 27

What is treatment for acute gastric volvulus?

Answer 27

Immediate surgical intervention to prevent ischemia and necrosis.

Question 28

What should be suspected when a patient presents with nausea, vomiting, ABDOMINAL PAIN, EARLY SATIETY, bloating, and weight loss?

Answer 28

Gastroparesis

Question 29

What is the number one etiology of gastroparesis?

Answer 29

Diabetes mellitus

Question 30

What is the best medication to treat gastroparesis?

Answer 30

Metoclopramide

MOA: unknown but seems to sensitize smooth muscle to ACh