Peptic Ulcer Disease Flashcards
When do peptic ulcers occur?
When balance between aggressive factors and defensive mechanisms are disrupted
What aggressive factors can alter mucosal defense?
NSAIDS, H pylori infection, bile salts and pepsin
How are ulcer sx characterized
Rhythmicity and periodicity
10-20% of ulcers occur w/o what?
Antecedent sx
Are NSAID induced ulcers symptomatic or asymptomatic?
Asymptomatic
Where are 95% of peptic ulcers found?
Bulb or pyloric channel
What percentage of benign ulcers are located in the antrum?
60%
What percentage of benign ulcers are located junction of the antrum and body on the lesser curvature?
25%
Do peptic ulcers occur more commonly in men or women?
Men
What makes patients more susceptible to peptic ulcers?
Smoking and taking NSAIDs
What are the 3 major causes of peptic ulcer disease?
NSAIDs
Chronic H pylori infection
Acid hypersecretory states
How many patients with H pylori will develop peptic ulcer disease?
1 in 6
What is the hallmark sx of peptic ulcer disease?
Epigastric pain in 80-90% of patients
What percentage of patients report relief of pain with food or antacids and recurrence 2-4hours later?
50%
2/3 of duodenal ulcers and 1/3 of gastric ulcers cause what to patients?
Nocturnal awakenings form pain
What imaging should be done for patients with peptic ulcers?
Upper endoscopy
How should patients be instructed to eat when being treated for peptic ulcers?
Balanced meals at regular intervals, no restrictive or bland diets
How should you treat peptic ulcer disease caused by NSAIDs?
Cessation of offending agent
PPI for 4-6 weeks
How do you treat H pylori associated ulcers?
PPI with antibiotics for 10-14 days
PPI for 4-6 weeks after that
How do you confirm eradication of h pylori?
Urea breath test, fecal antigen or endoscopy 4 weeks post completion of antibiotic and 1-2 weeks after PPI
