Peptic ulcer Disease

Question 1

MC location of DUs

Answer 1

First portion of the duodenum 95%

90 % located within 3 cm of the pylori a

Question 2

MC location of GUs

Answer 2

Distal to the junction between the Antrum and gastric secretory mucosa

Question 3

Mnemonic types of gastric ulcers

Answer 3

BAPC

Question 4

Chronic disorders shown to have strong association with PUD:

Answer 4

Advanced age
COPD
Chronic renal failure
Cirrhosis
Nephrolithiasis
Anti trypsin deficiency
Systemic mastic gross

Question 5

Appetite regulating hormone released by Cells in stomach

Answer 5

Gherkin

Question 6

Secretes HcL

Answer 6

Parietal cell oxyntic gland

Question 7

Receptors in parietal cell for stimulants of gastric acid secretion

Answer 7

Histamine
Gastrin
Acetylcholine

Question 8

When to repeat testing H pylori UbT after triple treatment

Answer 8

4 weeks

Question 9

When is recrudescence

Answer 9

Within 6 mos after therapy

Question 10

GU negative for Ca when to repeat endoscopy

Answer 10

8-12 weeks

Question 11

Define refractory ulcers

Answer 11

GU 12 weeks
DU 8 weeks
Doesn’t heal

Question 12

Pathognomonic of ZEs

Answer 12

bao> 15 in the presence of hyper gastrinemia

Question 13

Most sensitive gastric provocative test

Answer 13

Secretin study
>120 ph inc in gastric within 15 mins of secretin injection

Other pentagram run bao/Mao ration>0.6

Question 14

Mucosal defense system 3 layers

Answer 14

1) preepithelial
- mucus bicarbonate phospholipid later
2) epithelial
- mucus production
3) subepithelial
- elaborate microvascular system

Question 15

2 types of gastric acid production

Answer 15

1. Basal- circadian highest at nighyblow st in morning
2. Stimulated gastric acid secretion (3 phases)
   Cephalon, gastric, last phase

Question 16

GI hormone released by endocrine cells found in the gastric mucosa (D cells) in response HCl

Answer 16

Somatostatin

Question 17

Mechanism of acid production inhibition by somatostatin

Answer 17

Direct (parietal)

Indirect (histamine from ECG and gastric from G cells)

Question 18

Mechanism of action Ghrelin

Answer 18

Increase gastric acid secretion through stimulation of histamine release from ECL cells

Question 19

First step in eval of px with ZES

Answer 19

Obtain fasting gastric level

All gastrinoma px will have fasting gastinlecel >150-200

Next is assess gastric acid pH (should be less than 3)

Question 20

When to Obtain fasting gastrin level

Answer 20

Multiple ulcers 
Ulcers in unusual locations 
Ulcer px awaiting surgery 
Extensive family history for our 
Basal hyperchlorydia unexplained diarrhea or steatorrhea 
Hypercalcemia 
FH of pancreatic islet pituitary of parathyroid tumor 
prominent gastric or duodenal folds

Question 21

MC location of stress related mucosal injury

Answer 21

Fundus and body of stomach