Peptic Ulcer Disease

Question 1

Where in the body can ulcers develop? Where can they not develop?

Answer 1

They can develop anywhere in the body.

Question 2

Where do most ulcers occur?

Answer 2

~80% occur in the duodenum

Question 3

Other than the duodenum, where else do ulcers commonly form?

Answer 3

~20% in the stomach.

Question 4

T or F:

An increased amount of acid will cause ulcers

Answer 4

F, acid irritates the ulcers but does not cause them.

Question 5

What tissue layer do ulcers primarily affect? Can they go deeper than this layer?

Answer 5

The mucosa, yes they can go deeper than this.

Question 6

Is PUD common?

Answer 6

~10% prevalence.

Question 7

What is the pattern of recovery from PUD?

Answer 7

People with PUD may suffer from remissions and exacerbations .

Question 8

Can PUD ever be completely cured?

Answer 8

Yes, but it may return even if it has been completely cured. Bleak :/

Question 9

What is the main factor in the Et of PUD?

Answer 9

Helicobacter Pylori.

Question 10

How does the stomach protect itself from acid damage?

Answer 10

The mucosa provides protection.

Question 11

There is no mucosa in the duodenum, how does this structure withstand damage from acid?

Answer 11

The duodenum has by-chemical protection from the buffers in the pancreas.

Question 12

T or F:

The mucosa is able to regenerate itself after damage has occurred.

Answer 12

T

Question 13

Can perfusion be considered a defensive factor?

Answer 13

Yes.

Question 14

If the protective forces of the mucosa and duodenum are so effective, when does PUD occur?

Answer 14

When the offensive factors outweigh the defensive.

Question 15

Things to know about Helicobacter Pylori’s role in PUD:

3

Answer 15

• Needs a site
• Secretes adhesion proteins to adhere to site
• Secretes urease

Question 16

What does urease do?

Answer 16

Converts urea into CO2 and NH2

Question 17

What are some risk factors that contribute to the development of PUD?

Answer 17

• Helicobacter Pylori duh
• HCl and biliary acid
• NSAIDs
• Chronic gastritis
• Smoking, alcohol

Question 18

Explain how NSAIDs contribute to PUD:

Answer 18

Because of the decrease in prostaglandin synthesis, the mucosa’s ability to repair itself is hindered and it is more susceptible to damage.

Question 19

2 things caused by the presence of Helicobacter Pylori that contribute to the patho of PUD:

Answer 19

• Inflm -> tissue damage
• Hypergastrinemia -> increase in gastric secretions ->
  tissue damage

Question 20

What is gastrin?

Answer 20

A peptide hormone that stimulates secretion of HCl by the parietal cells of the stomach and aids in gastric motility.

Question 21

Where is gastrin released from?

Answer 21

G cells in the pyloric antrum of the stomach, duodenum, and the pancreas

Question 22

Mnfts of PUD:

Answer 22

• Burning/cramping abdm pain

- Nausea/vomiting

Question 23

With PUD, is nausea/vomiting a local or systemic mnft?

Answer 23

Local

Question 24

What are some complications that may arise d/t PUD?

Answer 24

• Hemorrhage
• Perforation
  
  • Peritonitis
• Obstruction

Question 25

What is used to Dx PUD?

Answer 25

• 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

Question 26

What is used in the management of PUD?

Answer 26

• Antacids for short term
• Triple regimen:
  
  • H2RA + 2 Abx
    - Zantac + Amoxil + Biaxin
  • PPI + 2 Abx
    - Losec + Flagyl + Biaxin

Question 27

What does a H2RA do to manage PUD?

Answer 27

Blocks acid secretion

Question 28

What does histamine stimulate?

Answer 28

The secretion of HCl acid

Question 29

What does a PPI do to manage PUD?

Answer 29

Blocks H secretion