PEPTIC ULCERE DISEASE Flashcards
Pertinent Anatomy of a patient with Peptic Ulcer Disease.
(1) Stomach
(2) Duodenum
What happens when the physiologic balance between gastric acid secretion and gastroduodenal mucosal is disrupted.
peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms is disrupted.
what can alter the mucosal defense by allowing back
diffusion of hydrogen ions and subsequent epithelial cell injury
nonsteroidal anti- inflammatory drugs (NSAIDs), H pylori infection, bile salts, acid, and pepsin
how are Ulcer symptoms characterized
rhythmicity and periodicity
what percentage of patients present with ulcer complications without
antecedent symptoms.
10-20%
do NSAID-induced ulcers have sxs
most of the time, no
what is the diagnostic procedure
of choice in most patients with H pylori
Upper endoscopy with gastric biopsy
Gastric ulcer biopsy or documentation of complete healing necessary to rule
out
malignancy
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
Peptic ulcer
ulcers extend through the muscularis mucosae and are usually over____
in diameter
5 mm
Ulcers occur five times more commonly in the duodenum, where over 95% are in the ______
bulb or pyloric channel.
duodenal ulcers most commonly occur in
patients between the ages of _____ years
30 and 55
gastric ulcers are more common in
patients between the ages of _____years.
55 and 70
Ulcers are more common in smokers and in patients taking _____
NSAIDs on a long-term
basis.
does Alcohol, dietary factors, and stress cause ulcer disease.
no
three major causes of peptic ulcer disease
(a) NSAIDs
(b) Chronic H pylori infection
(c) Acid hypersecretory states
______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.
H pylori
when is The risk of NSAID complications is greater
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.
Symptoms
(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.
Symptoms
(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.
. Differential Diagnosis
(a) acute pancreatitis,
(b) acute cholecystitis or choledocholithiasis,
(c) esophageal rupture,
(d) gastric volvulus,
(e) ruptured aortic aneurysm.
. Differential Diagnosis
(a) acute pancreatitis,
(b) acute cholecystitis or choledocholithiasis,
(c) esophageal rupture,
(d) gastric volvulus,
(e) ruptured aortic aneurysm.
Lab
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
RAD
(1) Upper endoscopy is the procedure of choice for the diagnosis of duodenal and gastric ulcers.
Disposition
May stay on the ship unless any red flags or not responsive to Proton pump inhibitor
therapy
Initial Care
(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.
