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peptic ulcer disease Flashcards

1
Q

How does peptic ulcer pain present?

A

hunger sensation, gnawing dull burning pain. Nausea

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2
Q

Where is the pain in peptic ulcers?

A

epigastric

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3
Q

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

A
  1. Onset 1-3 hrs after meals
  2. Awakens from sleep
  3. Relieved by food/antacid
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4
Q

What percentage of people have silent ulcers?

A

40%

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5
Q

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

A

60-90%

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6
Q

what are the three complications of peptic ulcers?

A

hemorrhage
perforation
obstruction

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7
Q

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

A
  1. POSTERIOR duodenal ulcers erode into major arteries

2. Gastric ulcers can lead to severe/persistent bleeding

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8
Q

What kinds of ulcers likely cause perforation?

A

anterior DU or GU

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9
Q

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

A

Free air in the peritoneal cavity

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10
Q

What is obstruction?

A

Scarring and stenosis of the gastric outlet.

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11
Q

What is a prominent feature of peptic ulcer obstruction?

A

Vomiting, often of old food

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12
Q

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

A

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

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13
Q

What is the benefit ofendoscopy?

A

Can take biopsies to exclude cancer and detect H pylori

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14
Q

What are the methods available for detecting H pylori?

A
  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
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15
Q

Where are gastric ulcers usually found?

A

On the lesser curvature of the stomach

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16
Q

Where are duodenal ulcers found?

A

In the duodenal bulb

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17
Q

jejunal ulcers are unusual. When might you see them?

A

In Zollinger Ellison syndrome

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18
Q

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

A

Merckel’s diverticulum with abnormal gastric mucosa

19
Q

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

A
  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
20
Q

How does PGE2 maintain mucosal integrity?

A
  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

21
Q

How do NSAIDS decrease PGE2?

A

Inhibition of cyclo-oxygenase-1–>PGE2

22
Q

What protects the duodenum from acid?

A

Brunner’s glands produce mucus with high buffer capacity

Also, biliary and pancreatic secretion have high bicarb

23
Q

What are other risk factors for peptic ulcer disease?

A 
Cigarette smoking (most important)
alcohol
coffee
psychological factors
Nsaids
24
Q

How does misoprostol work?

A

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

25
Q

Sulfated disaccarides

A

Sucralfate protects damaged mucosa

26
Q

What are other ulcerogenic drugs?

A

Indomethacin

27
Q

What are the side effects of tums?

A

Hypercalcemia can stimulate acid production, and release of gastrin

28
Q

What are the side effects of aluminum hydroxide?

A

constipation, anorexia, weakness, and bond pain

29
Q

What are the H2 receptor antagonists?

A

cimetidine, ranitidine, famotidine nizatidine

30
Q

What are the side effects of cimetidine?

A
  1. Mental confusion
  2. Gynecomastia
  3. Slows hepatic cytochrome P450 (higher levels of warfarin, diazepam, theophylline, phenytoin)
31
Q

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

A

DO NOT interfere with cytochrome P450

Less potent anti-androgen effects

32
Q

When should you give a PPI?

A

Before the first meal of the day

33
Q

How do PPIs work?

A

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

34
Q

What are the side effects of PPI?

A

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

35
Q

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

A

bixmuth, metronidazole, and tetracycline for 2 weeks

36
Q

What is zollinger-ellison syndrome?

A

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

37
Q

What are the clinical features of ZES?

A

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.

38
Q

Where are ulcers typically found in zollinger ellison?

A

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

39
Q

What do you need to diagnose ZES?

A

HIGH gastrin levels, and positive secretin stimulation test if needed

40
Q

What is the secretin test?

A

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

41
Q

What family of genetic disorders do you find ZES?

A

MEN1

42
Q

Where are gastrinomas found?

A

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

43
Q

what is the pathophysiology of acute stress ulcerations of stomach?

A

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

44
Q

What is Cushing’s ulcer?

A

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

GI (27 decks)

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