Peptic Ulcer Disease Lecture Powerpoint Flashcards
Regions of the stomach
Cardia (first part contains cardiac sphincter)
Fundus rounded dome left of cardia and below diaphragm
body - largest main part
antrum - lower part of stomach that holds food ready for small bowel
Pylorus (part of stomach that connects to the duodenum including pyloric sphincter)
Peptic ulcer disease definition
Break in lining of esophagus, stomach, or duodenum caused by corrosion due to acid* and pepsin**, most common in stomach and proximal duodenum, less common sites associated with zolinger ellison syndrome, hiatal hernieas, or ectopic gastric mucosa
Zollinger ellison syndrome
rare disorder with increased production of gastrin causing unopposed acid secretion typically due to pancreatic/duodenal gastrin secreting tumor, may be associated with multiple endocrine neoplasia type 1, presents with abdominal pain, diarrhea, heartburn
Peptic ulcer vs erosion
Ulcer is deeper, incites local inflammatory reaction and extends thru the muscularis mucosa while erosion is just partial
Excluding patients who use NSAIDS, __% of gastric and duodenal ulcers are associated with…
….H pylori infection
Peptic ulcer risk factors (5)
- NSAIDS
- H pylori infection
- severe physiologic stress
- hypersecretory states
- local radiation
H Pylori infection mech of action
Gram - spirochete that produces urease to alkanize microenvironment to survive the acidity oft he stomach and colonizes the gastri mucosa, this impairs duodenal bicarb secretion and increases levels of gastrin and pepsinogen which promotes gastric metaplasia in the duodenum increasing susceptibility to acid injury
NSAID gastric ulceration mech of action
Inhibition of cyclooxygenase decreasing prostaglandins resulting in decreased mucus and bicarb secretion, decreased epithelial cell proliferation, and decreased blood flow
Peptic ulcer disease clinical presentation (6) between gastric and duodenal ulcers
- burning epigastric pain typically after eating (gastric) with little relief with antacids
- nocturnal pain waking them up more characteristic of duodenal ulcer, which eating diminishes pain and is relieved with antacids
- dyspepsia
- heartburn
- anemia
- hematemesis or melena or hematochezia
Sudden onset of sharp pain often exacerbated by movement in peptic ulcer disease should raise concern for…
….perforation
Diagnostic study for peptic ulcer disease (2)
- EGD (can tell benign smooth regular ulcers and malignant irregular shaped ones)
- upper GI x ray series (back up if high risk for sedation)
H pylori infection testing
- Serum ELISA (useful only for first infection)
- urea breath test (highly accurate but expensive)
- stool antigen test
- endoscopic biopsy
How to screen for zollinger ellison syndrome (or a patient with multiple ulcers or strong family history)
-fasting serum gastrin level
A nonhealing gastric ulcer is…
…cancer until proven otherwise
Gastric cancer
3rd most common cause of cancer related death in the world, 5th most common globally, most often adenocarcinoma, early stages lacks symptoms while late stage sees sister mary joseph node and virchows node as well as N/V
Gastric cancers risk factors (4)
- h pylori infection
- chronic atrophic gastritis
- preserved or smoked food intake
- tobacco
Complications of vomiting (2)
- ruptured esophagus (boerhaave’s syndrome)
- mallory weiss tear
Gastroparesis and risk factors (3) and diagnostic study (1) and treatment
- Delayed emptying of the stomach due to issue with motility (NOT mechanical obstruction) sees nausea/vomitting, early satiety, and refractory reflux
- Risk factors include diabetes, parkinsons, myasthenia gravis
- gastric emptying study (radiograph to see how long it takes to move radiotagged substance thru GI, should be <1/2 hour for gastric emptying)
- Metoclopramide (acts on dopamine receptors, NEED to educate patient on watching out for tardive dyskinesias which can become irreversible)
Chief cells
Cells of the stomach that secrete pepsinogen that will be cleaved into pepsin for breaking down protein
Enteroendocrine cells produce ____ which stimulates other glands in the stomach
gastrin
Non urgent (hemodynamically stable) peptic ulcer dz treatment options (4)
- treat underlying cause
- limit risk factors
- add anti-secretory agent
- repeat endoscopy in 6-8 weeks to verify healing
H pylori treatment options (2)
- clarithromycin + amoxocilin or metronidazole
- proton pump inhibitor (PPI) twice a day
Urgent (hemodynamically unstable) peptic ulcer dz treatment options (3)
- urgent EGD
- PPI
- surgery or potential endoscopic balloon dilation
