PEPTIC ULCERE DISEASE

Question 1

Pertinent Anatomy of a patient with Peptic Ulcer Disease.

Answer 1

(1) Stomach

(2) Duodenum

Question 2

What happens when the physiologic balance between gastric acid secretion and gastroduodenal mucosal is disrupted.

Answer 2

peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms is disrupted.

Question 3

what can alter the mucosal defense by allowing back

diffusion of hydrogen ions and subsequent epithelial cell injury

Answer 3

nonsteroidal anti- inflammatory drugs (NSAIDs), H pylori infection, bile salts, acid, and pepsin

Question 4

how are Ulcer symptoms characterized

Answer 4

rhythmicity and periodicity

Question 5

what percentage of patients present with ulcer complications without
antecedent symptoms.

Answer 5

10-20%

Question 6

do NSAID-induced ulcers have sxs

Answer 6

most of the time, no

Question 7

what is the diagnostic procedure

of choice in most patients with H pylori

Answer 7

Upper endoscopy with gastric biopsy

Question 8

Gastric ulcer biopsy or documentation of complete healing necessary to rule
out

Answer 8

malignancy

Question 9

s a break in the gastric or duodenal mucosa that arises when the normal
mucosal defensive factors are impaired or are overwhelmed by aggressive luminal
factors such as acid and pepsin

Answer 9

Peptic ulcer

Question 10

ulcers extend through the muscularis mucosae and are usually over____
in diameter

Answer 10

5 mm

Question 11

Ulcers occur five times more commonly in the duodenum, where over 95% are in the ______

Answer 11

bulb or pyloric channel.

Question 12

duodenal ulcers most commonly occur in

patients between the ages of _____ years

Answer 12

30 and 55

Question 13

gastric ulcers are more common in

patients between the ages of _____years.

Answer 13

55 and 70

Question 14

Ulcers are more common in smokers and in patients taking _____

Answer 14

NSAIDs on a long-term

basis.

Question 15

does Alcohol, dietary factors, and stress cause ulcer disease.

Answer 15

no

Question 16

three major causes of peptic ulcer disease

Answer 16

(a) NSAIDs
(b) Chronic H pylori infection
(c) Acid hypersecretory states

Question 17

______appears to be a necessary cofactor for the majority of duodenal and gastric
ulcers not associated with NSAIDs. Overall, it is estimated that one in six infected
patients will develop ulcer disease.

Answer 17

H pylori

Question 18

when is The risk of NSAID complications is greater

Answer 18

1) within the first 3 months of therapy
2) who have a prior history of ulcer disease,
3) who take NSAIDs in combination with aspirin, corticosteroids, or anticoagulants.

Question 19

Symptoms

Answer 19

(1) Epigastric pain
(2) A change from a patient’s typical rhythmic discomfort to constant or radiating pain may
reflect ulcer penetration or perforation.
(3) Most patients have symptomatic periods lasting up to several weeks with intervals of
months to years in which they are pain free (periodicity).
(4) Nausea and anorexia may occur with gastric ulcers.
(5) The physical examination is often normal in uncomplicated peptic ulcer disease. Mild,
localized epigastric tenderness to deep palpation may be present.

Question 20

Symptoms

Answer 20

(1) Epigastric pain
(2) A change from a patient’s typical rhythmic discomfort to constant or radiating pain may reflect ulcer penetration or perforation.
(3) Most patients have symptomatic periods lasting up to several weeks with intervals of months to years in which they are pain free (periodicity).
(4) Nausea and anorexia may occur with gastric ulcers.
(5) The physical examination is often normal in uncomplicated peptic ulcer disease. Mild, localized epigastric tenderness to deep palpation may be present.

Question 21

. Differential Diagnosis

Answer 21

(a) acute pancreatitis,
(b) acute cholecystitis or choledocholithiasis,
(c) esophageal rupture,
(d) gastric volvulus,
(e) ruptured aortic aneurysm.

Question 22

. Differential Diagnosis

Answer 22

(a) acute pancreatitis,
(b) acute cholecystitis or choledocholithiasis,
(c) esophageal rupture,
(d) gastric volvulus,
(e) ruptured aortic aneurysm.

Question 23

Lab

Answer 23

1) Laboratory tests are normal in uncomplicated peptic ulcer disease but are ordered to exclude ulcer complications or confounding disease entities.
(2) An elevated serum amylase in a patient with severe epigastric pain suggests ulcer
penetration into the pancreas.
(3) In patients with a history of peptic ulcer or when an ulcer is diagnosed by upper gastrointestinal series, noninvasive assessment for H pylori with fecal antigen assay or urea breath testing should be done

Question 24

RAD

Answer 24

(1) Upper endoscopy is the procedure of choice for the diagnosis of duodenal and gastric ulcers.

Question 25

Disposition

Answer 25

May stay on the ship unless any red flags or not responsive to Proton pump inhibitor
therapy

Question 26

Initial Care

Answer 26

(1) In most cases d/c the causative agent which will reduce symptoms.
(2) For those with H Pylori induced, eradication of H Pylori is goal and then treat as would
peptic ulcer.