peptic ulcer disease

Question 1

How does peptic ulcer pain present?

Answer 1

hunger sensation, gnawing dull burning pain. Nausea

Question 2

Where is the pain in peptic ulcers?

Answer 2

epigastric

Question 3

What are the three things about the timing of peptic ulcer pain that are important?

Answer 3

1. Onset 1-3 hrs after meals
2. Awakens from sleep
3. Relieved by food/antacid

Question 4

What percentage of people have silent ulcers?

Answer 4

40%

Question 5

What percentage of people with ulcer like symptoms only have DYSPEPSIA w/o the ulcer?

Answer 5

60-90%

Question 6

what are the three complications of peptic ulcers?

Answer 6

hemorrhage
perforation
obstruction

Question 7

What are the two ways in which peptic ulcer hemorrhages might present?

Answer 7

1. POSTERIOR duodenal ulcers erode into major arteries

2. Gastric ulcers can lead to severe/persistent bleeding

Question 8

What kinds of ulcers likely cause perforation?

Answer 8

anterior DU or GU

Question 9

What would you see on X ray or CT scan in perforation?

Answer 9

Free air in the peritoneal cavity

Question 10

What is obstruction?

Answer 10

Scarring and stenosis of the gastric outlet.

Question 11

What is a prominent feature of peptic ulcer obstruction?

Answer 11

Vomiting, often of old food

Question 12

Why are the weaknesses of using barium radiograph to diagnose an ulcer?

Answer 12

It can’t tel the difference between a benign ulcer and a gastric cancer that has ulcerated

Question 13

What is the benefit ofendoscopy?

Answer 13

Can take biopsies to exclude cancer and detect H pylori

Question 14

What are the methods available for detecting H pylori?

Answer 14

1. Histology
2. rapid urease test on biopsy
3. urea breath test
4. Serum antibodies to H pylori (present after eradication of organism)
5. Stool antigen test

Question 15

Where are gastric ulcers usually found?

Answer 15

On the lesser curvature of the stomach

Question 16

Where are duodenal ulcers found?

Answer 16

In the duodenal bulb

Question 17

jejunal ulcers are unusual. When might you see them?

Answer 17

In Zollinger Ellison syndrome

Question 18

ileal ulcers are also unusual. When might you see them?

Answer 18

Merckel’s diverticulum with abnormal gastric mucosa

Question 19

What are the three ways in which H pylori causes chronic superficial gastritis?

Answer 19

1. Stimulating release of IL-1, IL-6, IL-8, and TNF-a
2. Gastric metaplasia, causing inflammation/ulceration
3. Suppression of somatostatin, causing hypergastrinemia

Question 20

How does PGE2 maintain mucosal integrity?

Answer 20

1. Stimulates mucus production
2. Increase mucosal blood flow (ischemia causes back diffusion of H+ ions, hemorrhage, and ulceration

Stimulation of bicarb, and epithelial migration/proliferation

Question 21

How do NSAIDS decrease PGE2?

Answer 21

Inhibition of cyclo-oxygenase-1–>PGE2

Question 22

What protects the duodenum from acid?

Answer 22

Brunner’s glands produce mucus with high buffer capacity

Also, biliary and pancreatic secretion have high bicarb

Question 23

What are other risk factors for peptic ulcer disease?

Answer 23

Cigarette smoking (most important)
alcohol
coffee
psychological factors
Nsaids

Question 24

How does misoprostol work?

Answer 24

It prevents NSAID ulcers. It’s a PGE2 that enhances mucosal production and reduces acid secretion

Question 25

Sulfated disaccarides

Answer 25

Sucralfate protects damaged mucosa

Question 26

What are other ulcerogenic drugs?

Answer 26

Indomethacin

Question 27

What are the side effects of tums?

Answer 27

Hypercalcemia can stimulate acid production, and release of gastrin

Question 28

What are the side effects of aluminum hydroxide?

Answer 28

constipation, anorexia, weakness, and bond pain

Question 29

What are the H2 receptor antagonists?

Answer 29

cimetidine, ranitidine, famotidine nizatidine

Question 30

What are the side effects of cimetidine?

Answer 30

1. Mental confusion 2. Gynecomastia 3. Slows hepatic cytochrome P450 (higher levels of warfarin, diazepam, theophylline, phenytoin)

Question 31

What are the side effects of ranitidine, famotidine, nizatidine?

Answer 31

DO NOT interfere with cytochrome P450 | Less potent anti-androgen effects

Question 32

When should you give a PPI?

Answer 32

Before the first meal of the day

Question 33

How do PPIs work?

Answer 33

They accumulate in the secretory canaliculus and block the H/K ATPase.

Question 34

What are the side effects of PPI?

Answer 34

VERY few! This is why it's the leading anti-acid. diarrhea and headache sometimes

Question 35

What cocktail of drugs would you use to eradicate H pylori?

Answer 35

bixmuth, metronidazole, and tetracycline for 2 weeks

Question 36

What is zollinger-ellison syndrome?

Answer 36

Also known as a gastrinoma, it results in hypersecretion of gastrin, and therefore hypersecretion of acid

Question 37

What are the clinical features of ZES?

Answer 37

Severe peptic ulcers that are resistant to medical therapy. They have a high frequency of bleeding and perforations. Will also see diarrhea, steatorrhea because acidic gastric secretions increase fluid in gut and absorptive fxns.

Question 38

Where are ulcers typically found in zollinger ellison?

Answer 38

Duodenum. If found in the jejunum, you KNOW this is ZES!!. Gastric ulcers are less common

Question 39

What do you need to diagnose ZES?

Answer 39

HIGH gastrin levels, and positive secretin stimulation test if needed

Question 40

What is the secretin test?

Answer 40

IV secretin normally suppresses gastrin release fro G cells. However, secretin will STIMULATE gastrin release in gastrinomas

Question 41

What family of genetic disorders do you find ZES?

Answer 41

MEN1

Question 42

Where are gastrinomas found?

Answer 42

duodenal wall, sometimes in the pancreas. Will often metastasize to the liver

Question 43

what is the pathophysiology of acute stress ulcerations of stomach?

Answer 43

Linear shallow defects in gastric mucosa. Pts are hyposecretors of acid. But also gastric mucosa breaks down from stress. Seen in ICU patients

Question 44

What is Cushing's ulcer?

Answer 44

Patients with intracranial trauma have HIGH acid secretion. Cushing's ulcer.