Peptic Ulcer Disease

Question 1

A peptic ulcer near the gastric outlet might lead to this symptom

Answer 1

Recurrent vomiting

Ulcer at gastric outlet blocks food passage so patient throws it back up

Question 2

Which test for h. pylori is good, but not often used since it requires anesthesia?

Answer 2

Endoscopic rapid urease test

Question 3

This type of testing is essential in peptic ulcer disease

Answer 3

H. pylori testing

Question 4

Treatment for peptic ulcer disease in a h. pylori positive person

Answer 4

PPI + clarithromycin + amoxicillin x 10-14 days

(clarithromycin + amoxicillin synergistic in treating h. pylori)

Question 5

This diagnostic lab is used in patients with ulcers refractory to treatment and suspicion of Zollinger-Ellison Syndrome

Answer 5

Serum gastrin level test

Question 6

Best tool, clinically, for H. pylori testing in peptic ulcer disease

Answer 6

Fecal antigen testing

Safer, cheaper, quicker than other options

Question 7

Why might upper GI radiography be used in a patient with peptic ulcer disease?

Answer 7

If penetration is suspected get an x-ray to identify free air under diaphragm

Question 8

Explain the mechanism by which NSAIDs increase risk of peptic ulcers

Answer 8

Inhibits COX-1 which reduces prostaglandin synthesis

This leads to less mucus secretion, less mucosal blood flow, and less bicarb to neutralize stomach acid

Question 9

How will pain presentation differ between gastric and duodenal peptic ulcers?

Answer 9

Gastric: pain shortly after meals

Duodenal: 2-3 hours after eating

Question 10

50-80% of these peptic ulcers wake patients at night

Answer 10

Duodenal ulcers

Question 11

Peptic ulcer diseases are diseases of these two areas

Answer 11

Stomach AND duodenum

Question 12

Three major risk factors for peptic ulcers

Answer 12

H. pylori

NSAIDs

Smoking

Question 13

High gastric acid production and/or impaired mucosal resistance leads to this condition

Answer 13

Peptic ulcers

Question 14

Is H. pylori prevalence higher in gastric or duodenal ulcers?

Answer 14

Duodenal ulcers

Question 15

Four treatment paths for peptic ulcer disease

Answer 15

Stop NSAIDs

Eradicate H. pylori

Smoking cessation

Antisecretory drugs

Question 16

A patient who is confirmed h. pylori negative, with multiple peptic ulcers that are treatment resistant, diarrhea, steatorrhea, and weight loss should receive this special test

Answer 16

Suspect Zollinger Ellison Syndrome

Do a serum gastrin level test

Question 17

Early satiety in a patient with suspected peptic ulcer disease is an alarming sign because it might suggest …

Answer 17

A gastric tumor

Question 18

Two most common major risk factors for acute stress peptic ulcers

Answer 18

> 48 hours of mechanical ventilation

Coagulopathy

Question 19

Three associated conditions, apart from ulcers, with Zollinger-Ellis Syndrome

Answer 19

Diarrhea

Steatorrhea (fat in diarrhea)

Weight loss

Question 20

Apart from gastric acid, which gastric enzyme contributes to erosion of the stomach wall in peptic ulcers?

Answer 20

Pepsin

Question 21

At what point in NSAID use is there the greatest risk of peptic ulcers?

Answer 21

Between days 7 and 30 of therapy

Question 22

Location of the gnawing or burning pain in peptic ulcers

Answer 22

Epigastric pain

Can refer to LUQ, RUQ, lower chest, mid-abdomen, back

Question 23

How are gastric ulcers treated differently to duodenal?

Answer 23

Same treatment but add an extra month of PPI

Question 24

A patient with peptic ulcers is shown to be h. pylori negative. What are your first steps before initializing treatment?

Answer 24

Check for NSAID use. If positive, switch to COX 2 if possible.

Consider endoscopy and biopsy

PPI for 4-8 weeks if gastrinomas present

Question 25

Treatment for perforated peptic ulcers

Answer 25

Broad spectrum antibiotics (bacteria getting out of GI tract into body)

Surgery and antisecretory drugs post-op

Question 26

Name this condition in which gastrin secreting gastrinomas cause ulcers at a multitude of different sites in the digestive tract

Answer 26

Zollinger-Ellison Syndrome

Question 27

Head injuries, burns, major surgeries, respiratory/renal/hepatic failure can cause acute stress peptic ulcers. These ulcers typically occur in this area of the digestive tract.

Answer 27

Fundus of stomach

Question 28

What is the difference between dysphagia and odynophagia?

Answer 28

Dysphagia = Difficulty swallowing

Odynophagia = Pain/discomfort with swallowing