Peptic Ulcer Disease

Question 1

Ulceration of the gastric mucosa, duodenum, and rarely the lower esophagus and jejunum

Answer 1

Peptic Ulcer Disease

Question 2

Most common PUD

Answer 2

Gastric and Duodenal

Question 3

Types of PUD

Answer 3

Gastric Ulcers
Duodenal Ulcers
Stress Ulcers

Question 4

resulted from stressful condition such as major surgery, sepsis, extensive burn injuries and hypoxia. Mostly involving the antrum of the stomach or duodenum causing hypoperfusion or ischemia to stomach lining

Answer 4

Curling’s Ulcer

Question 5

resulted from a traumatic head injury, stroke, brain tumor, brain surgery causing increased ICP that overstimulate the vagus nerve and increase HCL production

Answer 5

Cushing’s Ulcer

Question 6

removal of the stomach with attachment of the esophagus to the jejunum or duodenum (esophagojejunostomy)

Answer 6

Total Gastrectomy

Question 7

surgical division of the vagus nerve to eliminate the vagal impulses that stimulate HCL acid secretion in the stomach

Answer 7

Vagotomy

Question 7

removal of the lower half of the stomach (Antrectomy + Vagotomy)

Answer 7

Gastric Resection

Question 8

partial gastrectomy with remaining segment anastomosed to the duodenum (Vagotomy+ Antrectomy + Duodenum)

Answer 8

Gastroduodenostomy (Billroth I)

Question 9

partial gastrectomy with remaining segment anastomosed to the jejunum (Vagotomy+ Antrectomy + Jejunum)

Answer 9

Gastrojejunostomy (Billroth II)

Question 10

enlargement of the pyloric sphincter to prevent or decrease pyloric obstruction and enhancing gastric emptying

Answer 10

Pyloroplasty

Question 11

Rapid emptying of the gastric contents into the small intestine, occurs following gastric resection

Answer 11

Dumping Syndrome

Question 12

Complications: PUD

Answer 12

Hemorrhage
Perforation
Pyloric obstruction
Intractable disease

Question 13

Early signs of Dumping Syndrome (within 30 minutes after feeding)

Answer 13

Vertigo
Tachycardia
Syncope
Pallor
Desire to lie down

Question 14

Late signs of Dumping Syndrome (1hr 30 minutes - 3hrs after feeding)

Answer 14

Dizziness
Light-headedness
Palpitations
Diaphoresis
Confusion

Question 15

Stress, irregular hurried meals, smoking and alcoholism, caffeinated, fatty, spicy, acidic foods

Ulcerogenic medications, GI disorders - gastritis, Zollinger-Ellison Syndrome

Type A personality
Type O blood

Answer 15

Peptic Ulcer Disease

Question 16

Assessment: Peptic Ulcer Disease

Answer 16

Alcohol and tobacco use
Use of corticosteroids, NSAIDS, aspirin

Question 17

Epigastric tenderness, rigid, board like abdomen with rebound tenderness

Diminishing hyperactive bowel sounds, dyspepsia, vomiting

Answer 17

Peptic Ulcer Disease

Question 18

Drug Therapy: PUD

Answer 18

1. Triple Therapy (most successful regimen)
2. Hyposecretory Drugs
3. Mucosal Barrier Fortifiers

Question 19

Drug Therapy

Lowers gastric secretion and increases resistance of mucosa to injury

Contraindication: Pregnancy

Answer 19

Misoprostol (cytotec)

Question 20

Drug Therapy

Action - forms a seal over the ulcer, protecting it from irritation

Instruction - take 1hr before meals and at bedtime

Side effect - constipation

Answer 20

Sucralfate (carafate)

Question 21

Management for Hypovolemia: PUD

Answer 21

1. Monitor VS
2. Monitor serum electrolytes
3. Administer isotonic solutions
4. If active bleeding - administer fresh frozen plasma

Question 22

Management for Bleeding: PUD

Answer 22

1. Signs of shock
2. Perform gastric decompression or lavage
3. Avoid NSAIDS to minimize GI bleeding
4. Vasopressin (pitressin) - vasoconstricting drug

Question 23

Management: Dumping Syndrome

Answer 23

1. Small frequent feeding
2. Do not take fluids with meals
3. High protein, high fat, low to moderate carbohydrate diet
4. Administer Pectin

Question 24

Endoscopic Therapy: PUD

Answer 24

1. Thermal conduct
2. Inject bleeding site with diluted epinephrine
3. Laster therapy
4. Mechanical clip

Question 25

Endoscopic Therapy: PUD

heater probe or multi-electrocoagulation

Answer 25

Thermal contact

Question 26

Management for Dumping Syndrome

Diet

Answer 26

High protein, high fat, low to moderate carbohydrate diet

Question 27

Management for Dumping Syndrome

Medication to prevent the syndrome

Answer 27

Pectin