Peptic Ulcer Disease pg 2206 Flashcards
pathophysiology of peptic ulcers
a break in the gastric and duodenal mucosa that arises when the mucosal defensive factors are impaired or overwhelmed by luminal factors such as acid and pepsin
ulcers that extend through the muscularis mucosa are usually what size by definition?
over 5 mm in diameter
peptic ulcers occur five times more commonly in this location, and 95% of those are in which locations?
duodenum, usually in the bulb or pyloric channel
duodenal ulcers are more common in which age group? gastric ulcers are common in which age group?
Duodenal- 30-55 yo
Gastric- 55-70
what are the three major causes of peptic ulcer disease?
NSAIDs
H Pylori
Acid Hypersecretory states
in the absence of antibiotic therapy, what percentage of patients will have a recurrence if not treated for H pylori ulcerations?
85%
The risk of NSAID ulcer complications is greater in what conditions?
within first 3 months of therapy
who have a prior history of ulcer disease
who take NSAIDS in combo with aspirin, corticosteroids, and anticoagulants
Sx of peptic ulcers
epigastric pain (sometimes awakening the patient, more often if in the duodenum)
change in rhythmic discomfort suggests penetration or perforation
gastric ulcers may present with nausea or anorexia
why would you order labs for peptic ulcer disease?
normally normal if uncomplicated. must exclude complications and confounding disease entities.
an elevated serum lypase in a patient with severe epigastric pain suggest ulcer penetration into what organ?
pancreas
Treatment for peptic ulcers
dependent on etiology.
NSAID induced- Stop offending agent, take PPI
H Pylori- triple antibiotic therapy with PPI
disposition of Peptic Ulcer Disease?
stay on ship unless red flags or not responsive to PPI
