Peptic Ulcer Disease

Question 1

Alarm sxs for ulcer

Answer 1

weight loss, bleeding, anemia

Question 2

Dyspepsia sxs

Answer 2

epigastric pain/discomfort +/- fullness, early satiety, bloating, nausea

Question 3

What is functional dyspepsia?

Answer 3

Dyspepsia sxs x 12 weeks without evidence of ulcer on endoscopy

Question 4

% association of H. pylori w/ ulcertype

Answer 4

• 30-60% with gastric ulcers

- 50-70% with duodenal ulcers

Question 5

Duodenal ulcer sxs

Answer 5

sxs after stomach emptied but food-stimulated acid production (2-5 hours post prandial), worsened at nighttime due to circadian increase in acid production, pain relief with food or antacids

Question 6

Gastric ulcer sxs

Answer 6

More variable – pain worsened or unchanged with food/antacids

Question 7

Percent malignancy of gastric ulcers

Answer 7

5-10%, should get scope with bx

Question 8

Gastric CA sxs based on location:

Answer 8

1) cardia – dysphagia
2) pylorus – persistent vomiting
3) stomach wall – early satiety (mass effect or infiltration)

Question 9

Red flags for gastric CA

Answer 9

1) Age >45 with new onset dyspepsia
2) weight loss, recurrent vomiting, dysphagia, GI bleed, iron deficiency anemia
3) failed empiric therapy

Question 10

Work-up of younger pts without alarm sxs

Answer 10

1) urea breath test to check active infection

2) H pylori antibody test, evidence of prior infection

Question 11

Treatment of H. pylori

Answer 11

14 days: omeprazole + clarithromycin + metronidazole or amoxicillin

Question 12

Treatment of H. pylori if PCN allergic or fails initial therapy

Answer 12

14 days: bismuth salicylate + metronidazole + tetracycline

Question 13

H. pylori infection increases risk for ____ and ____.

Answer 13

1) Gastric carcinoma

2) Gastric MALT lymphoma (mucosa-associated lymphoid tissue)

Question 14

Etiologies of PUD

Answer 14

H. pylori, NSAIDS, Zollinger-Ellison Syndrome (rare, gastrin producing tumor)

Question 15

Pathophys: NSAIDS and ulcer formation

Answer 15

impair local defense to acid damage – inhibits gastroduodenal prostaglandin synthesis leading to reduced mucous and bicarb secretion and reduced blood flow

Question 16

When to suspect Zollinger-Ellison Syndrome

Answer 16

ulcers refractory to standard medical therapy, ulcers in unusual locations (beyond duodenal bulb), no evidence of H pylori or NSAID use

Question 17

How to diagnose Zollinger-Ellison syndrome

Answer 17

fasting gastrin levels, if elevated get CT/MRI to localize tumor

Question 18

Complications of PUD

Answer 18

• hemorrhage (most common and severe)
• free perforation into abd cavity
• gastric outlet obstruction in chronic ulceration