Peptic Ulcer Disease Flashcards
A peptic ulcer near the gastric outlet might lead to this symptom
Recurrent vomiting
Ulcer at gastric outlet blocks food passage so patient throws it back up
Which test for h. pylori is good, but not often used since it requires anesthesia?
Endoscopic rapid urease test
This type of testing is essential in peptic ulcer disease
H. pylori testing
Treatment for peptic ulcer disease in a h. pylori positive person
PPI + clarithromycin + amoxicillin x 10-14 days
(clarithromycin + amoxicillin synergistic in treating h. pylori)
This diagnostic lab is used in patients with ulcers refractory to treatment and suspicion of Zollinger-Ellison Syndrome
Serum gastrin level test
Best tool, clinically, for H. pylori testing in peptic ulcer disease
Fecal antigen testing
Safer, cheaper, quicker than other options
Why might upper GI radiography be used in a patient with peptic ulcer disease?
If penetration is suspected get an x-ray to identify free air under diaphragm
Explain the mechanism by which NSAIDs increase risk of peptic ulcers
Inhibits COX-1 which reduces prostaglandin synthesis
This leads to less mucus secretion, less mucosal blood flow, and less bicarb to neutralize stomach acid
How will pain presentation differ between gastric and duodenal peptic ulcers?
Gastric: pain shortly after meals
Duodenal: 2-3 hours after eating
50-80% of these peptic ulcers wake patients at night
Duodenal ulcers
Peptic ulcer diseases are diseases of these two areas
Stomach AND duodenum
Three major risk factors for peptic ulcers
H. pylori
NSAIDs
Smoking
High gastric acid production and/or impaired mucosal resistance leads to this condition
Peptic ulcers
Is H. pylori prevalence higher in gastric or duodenal ulcers?
Duodenal ulcers
Four treatment paths for peptic ulcer disease
Stop NSAIDs
Eradicate H. pylori
Smoking cessation
Antisecretory drugs
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
Suspect Zollinger Ellison Syndrome
Do a serum gastrin level test
Early satiety in a patient with suspected peptic ulcer disease is an alarming sign because it might suggest …
A gastric tumor
Two most common major risk factors for acute stress peptic ulcers
> 48 hours of mechanical ventilation
Coagulopathy
Three associated conditions, apart from ulcers, with Zollinger-Ellis Syndrome
Diarrhea
Steatorrhea (fat in diarrhea)
Weight loss
Apart from gastric acid, which gastric enzyme contributes to erosion of the stomach wall in peptic ulcers?
Pepsin
At what point in NSAID use is there the greatest risk of peptic ulcers?
Between days 7 and 30 of therapy
Location of the gnawing or burning pain in peptic ulcers
Epigastric pain
Can refer to LUQ, RUQ, lower chest, mid-abdomen, back
How are gastric ulcers treated differently to duodenal?
Same treatment but add an extra month of PPI
A patient with peptic ulcers is shown to be h. pylori negative. What are your first steps before initializing treatment?
Check for NSAID use. If positive, switch to COX 2 if possible.
Consider endoscopy and biopsy
PPI for 4-8 weeks if gastrinomas present
