Peptic Ulcer Disease

Question 1

relation of Tobacco smoking, alcohol, and steroids to Peptic Ulcer Disease

Answer 1

1-do not cause ulcer disease

2-can delay healing and are associated with the development of gastritis

Question 2

NSAIDs can cause ulcer formation because

Answer 2

1-because they decrease the normal production of
the mucous barrier protecting the epithelial cells of the gastric mucosa.
2-Prostaglandins, the major stimulant for mucous production that forms this protective barrier, are
inhibited by NSAIDs and hence diminish the protective barrier of the stomach lining

Question 3

The most common cause of ulcer disease is

Answer 3

Helicobacter pylori followed by the use of

NSAIDs;

Question 4

Clinical Presentation of Peptic Ulcer Disease

Answer 4

1-midepigastric pain.
2-Gastric ulcer is often associated with pain on eating (frequently leading to weight loss)
3-while duodenal ulcer is thought to be relieved by eating
4-endoscopy is still required for a definite diagnosis

Question 5

Tenderness of the abdomen relation to PUD

Answer 5

unusual with ulcer disease

Question 6

Nausea and vomiting relation to PUD

Answer 6

found with both of them duodenal and peptic ulcer

Question 7

Diagnosis of PUD

Answer 7

1-best diagnosed with upper endoscopy.Barium studies are inferior.
2-If patient age <50 and has no alarm symptoms, test and treat for H. pylori. If H. pylori
is negative, give trail of proton-pump inhibitors (PPIs). If symptoms persist, perform
endoscopy.
3-If patient age >50 or has alarm symptoms (weight loss, anemia, heme-positive stools,
or dysphagia), perform endoscopy.

Question 8

The diagnosis of H. pylori is based on

Answer 8

1-urea breath testing,
2-stool antigen testing,
3-or biopsy with histology
4-or rapid urease testing.

Question 9

Before testing for H. pylori, make sure the patient is

Answer 9

off PPIs for 2 weeks and antibiotics for 4 weeks, as they can cause false-negatives.

Question 10

Treatment of Peptic Ulcer Disease

Answer 10

treatment of ulcer disease centers largely on the treatment of H. pylori.
- Use a proton pump inhibitor (PPI) combined with clarithromycin and amoxicillin. The PPIs omeprazole,
lansoprazole,

Question 11

Testing for eradication of H.Pylori is indicated only for

Answer 11

• Wait 4−8 weeks after treatment to check for eradication. Do not use serology to test
for eradication.
• If the organism was not eradicated, then repeat treatment with different antibiotics,
plus bismuth subsalicylate. Explore sensitivity testing for the organism.
• If the organism was eradicated and the ulcer persists or worsens, consider evaluating
the patient for Zollinger-Ellison syndrome.

Question 12

ulcers not related to Helicobacter can be treated with

Answer 12

PPIs alone

Question 13

Give PPI for prophylaxis if patient is high risk. Risk factors include:

Answer 13

• History of PUD or GI bleed
• Age 65 years or older
• Chronic comorbid illness
• High-dose NSAID use
• Concomitant use of aspirin (of any dose), anticoagulants, other NSAIDs, or glucocorticoids

Question 14

Indications for surgery in peptic ulcer disease (PUD):

Answer 14

• UGI bleed not amenable to endoscopic procedures
• Perforation
• Refractory ulcers
• Gastric outlet obstruction (can change endoscopic dilation)

Question 15

define Gastritis

Answer 15

inflammation, erosion, or damage of the gastric lining that has not developed into
an ulcer.

Question 16

Causes of Type B gastritis

Answer 16

(most common) can be caused by alcohol, NSAIDs, Helicobacter, head trauma, burns, and mechanical ventilation.
It is also associated with increased gastric
acid production.

Question 17

Causes of Type A gastritis

Answer 17

1-atrophy of the gastric mucosa and associated with an
autoimmune process such as vitamin B12 deficiency.
2-It is also associated with diminished gastric acid production and achlorhydria.

Question 18

Clinical Presentation of Gastritis

Answer 18

1-asymptomatic bleeding
2-abdominal pain
3-Nausea and vomiting

Question 19

Diagnosis and Treatment of Gastritis

Answer 19

• Diagnosis and treatment of Helicobacter are the same as that for gastritis
• Diagnosis of vitamin B12 deficiency and pernicious anemia are made initially with low B12 and increased methylmalonic acid.
• Pernicious anemia is confirmed with the presence of antiparietal cell antibodies and anti-intrinsic factor antibodies; treatment is B12 replacement, as with all cases of B12 deficiency.

Question 20

define Zollinger-Ellison Syndrome

Answer 20

1-hypergastrinemia caused by cancer of the gastrin-producing cells. There is no known cause for gastrinoma or ZES
2-Half of these gastrinomas are located in the duodenum, and 25% in the pancreas

Question 21

Clinical Presentation of Zollinger-Ellison Syndrome

Answer 21

More than 95% of patients with ZES present with ulcer disease.

Question 22

Diagnosis of Zollinger-Ellison Syndrome

Answer 22

1-an elevated gastrin level is indicative of ZES, remember that all patients on H2 blockers or PPIs have elevated gastrin
2-That is because the main stimulus to the suppression
of gastrin release is acid. If acid production is suppressed.
3- then gastrin goes up. So to diagnose ZES, gastrin must be found elevated after the patient has been off antisecretory therapy for several days.

Question 23

Other causes of increased gastrin include

Answer 23

• Pernicious anemia
• Chronic gastritis
• Renal failure
• Hyperthyroidism

Question 24

After confirming a diagnosis of gastrinoma, the most important step is to determine if the
lesion is

Answer 24

• Localized lesions can be surgically removed.
• Metastatic disease can be suppressed only with PPIs
–– U/S, CT, and MRI have 60–80% sensitivity for the presence of metastatic disease—
specific enough to prove the presence of tumor if positive but not sensitive enough
to safely exclude disease if negative

Question 25

tests for diagnosis of Zollinger-Ellison Syndrome

Answer 25

• A nuclear test, somatostatin-receptor scintigraphy, is 90% sensitive for the detection of
metastatic disease. The single most sensitive test is the endoscopic U/S. Typically, both
tests are done.

Question 26

Treatment of Zollinger-Ellison Syndrome

Answer 26

Localized disease is surgically resected and metastatic disease is treated with the long-term administration of PPIs simply to block acid production.

Question 27

define Gastroparesis

Answer 27

delayed gastric emptying, results in delayed movement of food from the stomach to the small intestine.

Question 28

Clinical Presentation of Gastroparesis

Answer 28

1-early satiety, 
2-postprandial nausea,
3-a general sense of increased abdominal fullness 
4-abdominal pain and bloating
5-long-standing history of diabetes

Question 29

Diagnosis of Gastroparesis

Answer 29

1-often diagnosed clinically

2-gastric-emptying study is the confirmatory test

Question 30

Treatment of Gastroparesis

Answer 30

agents that will increase motility of the stomach, such as erythromycin or metoclopramide