Peptic Ulcer Disease Flashcards
Where in the body can ulcers develop? Where can they not develop?
They can develop anywhere in the body.
Where do most ulcers occur?
~80% occur in the duodenum
Other than the duodenum, where else do ulcers commonly form?
~20% in the stomach.
T or F:
An increased amount of acid will cause ulcers
F, acid irritates the ulcers but does not cause them.
What tissue layer do ulcers primarily affect? Can they go deeper than this layer?
The mucosa, yes they can go deeper than this.
Is PUD common?
~10% prevalence.
What is the pattern of recovery from PUD?
People with PUD may suffer from remissions and exacerbations .
Can PUD ever be completely cured?
Yes, but it may return even if it has been completely cured. Bleak :/
What is the main factor in the Et of PUD?
Helicobacter Pylori.
How does the stomach protect itself from acid damage?
The mucosa provides protection.
There is no mucosa in the duodenum, how does this structure withstand damage from acid?
The duodenum has by-chemical protection from the buffers in the pancreas.
T or F:
The mucosa is able to regenerate itself after damage has occurred.
T
Can perfusion be considered a defensive factor?
Yes.
If the protective forces of the mucosa and duodenum are so effective, when does PUD occur?
When the offensive factors outweigh the defensive.
Things to know about Helicobacter Pylori’s role in PUD:
3
- Needs a site
- Secretes adhesion proteins to adhere to site
- Secretes urease
What does urease do?
Converts urea into CO2 and NH2
What are some risk factors that contribute to the development of PUD?
- Helicobacter Pylori duh
- HCl and biliary acid
- NSAIDs
- Chronic gastritis
- Smoking, alcohol
Explain how NSAIDs contribute to PUD:
Because of the decrease in prostaglandin synthesis, the mucosa’s ability to repair itself is hindered and it is more susceptible to damage.
2 things caused by the presence of Helicobacter Pylori that contribute to the patho of PUD:
- Inflm -> tissue damage
- Hypergastrinemia -> increase in gastric secretions ->
tissue damage
What is gastrin?
A peptide hormone that stimulates secretion of HCl by the parietal cells of the stomach and aids in gastric motility.
Where is gastrin released from?
G cells in the pyloric antrum of the stomach, duodenum, and the pancreas
Mnfts of PUD:
- Burning/cramping abdm pain
- Nausea/vomiting
With PUD, is nausea/vomiting a local or systemic mnft?
Local
What are some complications that may arise d/t PUD?
- Hemorrhage
- Perforation
- Peritonitis
- Obstruction
What is used to Dx PUD?
- Urea breath test (based on the presence of urease)
- Serology (specifically looking for Ags against
Helicobacter Pylori, not routine) - Fecal Ags (not routine)
- Gastroscopy (long wait)
- Barium swallow
What is used in the management of PUD?
- Antacids for short term
- Triple regimen:
- H2RA + 2 Abx
- Zantac + Amoxil + Biaxin - PPI + 2 Abx
- Losec + Flagyl + Biaxin
- H2RA + 2 Abx
What does a H2RA do to manage PUD?
Blocks acid secretion
What does histamine stimulate?
The secretion of HCl acid
What does a PPI do to manage PUD?
Blocks H secretion
