Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine I: Gastroenterology > Peptic Ulcer Disease and Gastritis > Flashcards

Peptic Ulcer Disease and Gastritis Flashcards

1
Q

What are the 3 primary causes of peptic ulcer disease and what are the major risk factors for developing PUD?

A

3 primary causes of PUD: H. pylori infection, NSAID abuse, use and stress related gastric mucosal damage (shock, hypotension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for PUD?

A
  • H. pylori infection
  • NSAID use
  • Gastric acid hypersecretion
  • EtOH (increased susp. to HP)
  • Smoking (alters gastric motility; increased oxygen free radicals)
  • Ischemia
  • Stress (sepsis, shock, mechanical ventilation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What tests can be used to determine the presence of gastritis, H. pylori infection and other causes of PUD?

A

EGD (upper endoscopy) is the best single evaluation to establish gastritis (and PUD), H. pylori by biopsy! Stool antigen before and after treatment, antibody before, urea breath test before and after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where do most H. pylori ulcers predominantly occur?

A

Most common place for ulcer is duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the “gold standard” for diagnosing H. pylori and what other tests can be used to confirm this diagnosis?

A

x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can its eradication be confirmed?

A

x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

x

A

H. pylori - Resides primarily in antrum (is the initial portion of the pyloric part of the stomach. It is near the bottom of the stomach, proximal to the pyloric sphincter, which separates the stomach and the duodenum.), but can migrate proximally. Generally does not invade the epithelial cells. Cause 90% of duodenal ulcers and up to 80% of gastric ulcers. Only 15% of H.pylori infected pts develop PUD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

x

A
  • Endoscopy: > 90% sensitivity
  • Upper GI series 60-90% sensitivity
  • H. pylori testing (endoscopic bx, serologic antibody, stool antigen testing) - A serum H pylori antibody would not be a good test with a peptic ulcer bc they might have had it before and they will still have the antibody
  • Empiric trial of acid suppression for 2-4 wks and H.pylori testing ?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

x

A

H. pylori testing

  • HP antibody serology (previous or current infection)
  • Histologically on biopsy
  • Stool antigen test (sens./specificiy >90%)
  • Urea breath test
  • Re-test 4-6 weeks after Rx (prescription) for eradication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What treatments are available for the eradication of H. pylori as well as treatment of symptomatic gastritis? – don’t need to know doses

A

Helidac = metronidazole, tetracycline, bismuth subsalicylate +h2-antagonist (beta lactam allergic) or prevpac = lansoproazole (PPI), biaxin (clarithromycin) and amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treat H. pylori:

A
  • Proton pump inhibitor bid + Amoxacillin 1.0 gm bid + clarithromycin 500 mg bid x 14 days (80-95% efficacy)
    OR
  • Omeprazole 20 mg bid + Bismuth 2 tabs qid + tetracycline 500 mg qid + metronidazole 500 mg tid x 14 days (90-95% efficacy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PUD treatment:

A
  • Discontinue NSAIDS
  • Treat for H. pylori if present
  • Acid suppression
  • Re-endoscope gastric ulcers to assess healing and r/o malignancy; duodenal ulcers do not need repeat endoscopy
  • Quit smoking/drinking
  • Surgery rarely needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PUD Medical Therapies:

A

CHART

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the major causes of gastritis?

A

H. pylori, NSAID abuse and stress related gastric mucosal damage, autoimmune gastritis, lymphocytic/eosinophilic gastritis, CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 2 types of gastritis?

A

Type A – Atrophic Gastritis & Type B – Nonatrophic Gastritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of vitamin deficiency can be caused by gastritis and where do they predominantly occur?

A

Macrocytic anemia with a vitamin b12 deficiency

17
Q

Type A – Atrophic Gastritis

A
  • Can be autoimmune vs multifocal gastritis
  • Less common
  • Can be associated with pernicious anemia
  • Primarily involves fundus and body
  • Spares antrum
  • Can be associated with H.pylori, but not common
18
Q

Type B – Nonatrophic Gastritis

A
  • More common
  • Generally associated with H.pylori
  • Antral-predominant gastritis
  • Can expand to involve entire stomach
19
Q

Gastritis can be caused by irritation due to excessive alcohol use, chronic vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory drugs. It may also be caused by any of the following:

A

Helicobacter pylori (H. pylori): A bacteria that lives in the mucous lining of the stomach. Without treatment the infection can lead to ulcers, and in some people,stomach cancer.

Pernicious anemia: A form of anemia that occurs when the stomach lacks a naturally occurring substance needed to properly absorb and digest vitamin B12.

Bile reflux: A backflow of bile into the stomach from the bile tract (that connects to the liver and gallbladder).
Infections caused by bacteria and viruses.

20
Q

Treatment for gastritis usually involves:

A

Taking antacids and other drugs to reduce stomach acid, which causes further irritation to inflamed areas.
Avoiding hot and spicy foods.
For gastritis caused by H. pylori infection, your doctor will prescribe a regimen of several antibiotics plus an acid blocking drug (used for heartburn).
If the gastritis is caused by pernicious anemia, B12 vitamin shots will be given.
Eliminating irritating foods from your diet such as lactose from dairy or gluten from wheat.
Once the underlying problem disappears, the gastritis usually does, too.

21
Q

What rare type of gastric cancer is associated with H. pylori infection that generally goes into remission with eradication of the organism?

A

MALT lymphoma (abnormal proliferation of B-lymphocytes)

Associated with gastric cancer
– Adenocarcinoma
– MALToma (Mucosa Associated Lymphoid Tissue-oma) – goes into remission with eradication H. pylori

22
Q

What is PUD?

A

Imbalance between aggressive and defensive factors in the gastroduodenal mucosa.

Factors:
H. pylori, NSAIDS, acid secretory abnormalities

23
Q

How does a patient present with PUD?

A
  • Deep, gnawing or burning pain in the epigastric region.
  • Onset 1-3 hours after eating, awaken at night
  • Relief with food
  • Nausea with or without vomiting
24
Q

What are the physical exam findings of a patient with PUD?

A
  • Tenderness in RUQ/epigastrium

- Maybe peritoneal signs

25
Q

How do we diagnose PUD?

A
  • H. pylori testing (Breath test)
  • CBC
  • EGD with biopsy
26
Q

What is the treatment for PUD?

A
  • Lifestyle changes
  • H. pylori therapy: Bismuth, metronidazole, tetracycline or amoxicillin, and omeprazole
  • Antacids
  • H2 blockers
  • Proton pump inhibitors

Triple therapy: PPI or bismuth with two of the above antibiotics for 7-14 days.

27
Q

What is Zollinger-Ellison Syndrome?

A

A gastrin producing tumor leads to refractory PUD

28
Q

What are the clinical manifestations of Zollinger-Ellison Syndrome?

A

Same symptoms as with PUD

29
Q

What are the expected significant lab results for Zollinger-Ellison Syndrome?

A

Labs
Elevated gastrin level
EGD: multiple ulcers

30
Q

What is the treatment for Zollinger-Ellison Syndrome?

A

Proton pump inhibitors

Surgical resection

31
Q

Gastric Neoplasms

A

Adenocarcinoma: Men > women, Never younger than 40 year old

Lymphoma:

  • Stomach is common site for non-Hodgkin’s lymphoma
  • Increase risk with H. pylori infection
32
Q

What are the clinical manifestations of gastric neoplasms?

A

Dyspepsia, weight loss, occult bleeding, progressive dysphagia, postprandial vomiting

33
Q

What is the treatment for gastric neoplasms?

A
  • Surgery
  • Chemotherapy
  • Radiation therapy

Medicine I: Gastroenterology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions