Peptic Ulcer disease

Question 1

PUD Causes/incidents

Answer 1

H pylori ( present In > 90% of duodenal and 75% in gartroc ulcers )

Medication such as NSAIDs ,aspirin and glucocorticoids

Most common in men

• • duodenal ulcers between 30–55
• • gastric ulcers between ages 55–65

What is common in greater than half a pack per day smokers

Question 2

PUD Signs/Symptoms

Answer 2

Gnawing epigastric pain
Relief with eating (duodenal)
Pain worsens with eating ( gastric)

Question 3

PUD Physical findings

Answer 3

Often unremarkable; may know some mild epigastric tenderness

G.I. bleeding 20% of cases, Melena, heMetemesis or coffee ground emesis

** perforation 5–10% of cases: severe epigastric pain, board like abdomen, quiet bowel sounds, rigidity and other signs of an acute abdomen

Question 4

PUD Lab/Diagnostics

Answer 4

Normal; May note anemia on the CBC test

Consider endoscopy after 8 to 12 weeks of treatment

Consider H pylori testing

Question 5

H2 Receptor Antagonists

Answer 5

Cimetidine 800 mg HS
Famantidine 40 mg HS
Nizatidine 300mg HS

Question 6

PPI

Answer 6

Lansoprazole 15 mg daily
Rabeprazole 20mg daily
Pantoprazole 40 mg daily
Omeprazole 20 mg daily
Dexlansoprazole 30mg daily
Esomeprazole 20mg daily

Question 7

Mucosal protective agents

Answer 7

Sucralfate 1 g 4 times a day
Bismuth subsalicylate (pepto-bismol)
Mylanta, Maalox, MOM

Question 8

Sucralfate

Answer 8

1g 4x/day
Requires an acidic environment avoid anti-acids and H2 blockers

Associated with decreases in nosocomial pneumonia

Question 9

Bismuth Subsalicylate

Peptide-Bismol

Answer 9

Has direct antibacterial action against H. Pylori

Promotes prostaglandin production stimulates gastric HCO3

Question 10

Antacids

MyLanta, Maalox, milk of magnesia

Answer 10

Do not reduce the amount of gastric acidity

Question 11

H. Pylori Eradication therapy

Answer 11

** combination options: two antibiotics plus a proton pump inhibitor with or without bisma for 10–14 days

Question 12

H. Pylori Treatment

Not allergic to penicillin and have not previously received a macrolide

Answer 12

ECA - esomeprazole Plus clarithromycin plus amoxicillin x 14 days

EBMT- esomeprazole Plus bismuth plus Metronidazole plus tetracycline X 10 Dash 14 days

ECAM- Esomeprazole Plus clarithromycin plus amoxicillin plus metronidazole X 10–14 days

Question 13

H.pylori Treatment

Allergic to penicillin and have not previously received a macrolide or are unable to tolerate bismuth 

Answer 13

ECM - ESomeprazole Plus clarithromycin plus metronidazole X 10–14 days

Question 14

H. Pylori Treatment

Allergic to penicillin and who have previously received a macrolide

Answer 14

EBMT -Esomeprazole Plus bismuth plus metronidazole plus tetracycline X 10-14 days

Question 15

H. Pylori

Antiulcer therapy

Answer 15

Recommended following the previous regiments for 3 to 7 weeks to ensure a symptom relief in ulcer healing

PPI make me continued for seven additional weeks

H2 blockers or sucralfate can be given for 6 to 8 weeks

Question 16

In hospital management for Peptic ulcer disease bleeding ulcers and potential perforation

Answer 16

IV access
Fluid and blood products
Baseline lab studies: CDC, PT, PTT, BMP
O2
Endoscopy
Urinary catheterization
NPO/NG tube for Lavage
Upright or decubious films show free air in 75% of cases
Monitor abdomen: quiet, rigid with rebound tenderness
IV H2 blockers
If Coagulopathy present give fresh frozen plasma
If thrombocytopenia less than 50,000 exist transfuse platelets
G.I. surgical evaluation