PUD Flashcards
1
Q
PUD
A
- the deeper the ulcer penetrates, the more damage it can do, more likely to see GI bleeding
- Symp: dyspepsia associated with food
- DU: food helps buffer pain
- GU: food worsens pain
2
Q
PUD complications
A
GI bleeding
3
Q
PUD causes
A
- H. pylori
- NSAIDS
- Critical illness
4
Q
H. pylori
A
-#1 cause
-DU more than GU
-Diagnosis: endoscopy and blood tests
Confirm eradication: breath tests and fecal antigen tests
5
Q
Reduce pain, heal ulcer
A
PPI
6
Q
Prevent reoccurrence and eliminate H. pylori
A
abx
7
Q
triple therapy
A
PPI bid, clarithromycin, amoxicillin
8
Q
Bismuth quad therapy (#1)
A
- PPI BID
- Bismuth subsylisalate or subsitrate QID
- Tetracycline
- Metronidazole
9
Q
Levofloxacin triple therapy (#2)
A
- PPI BID
- Levo
- Amox
10
Q
Penicillin allergy
A
sub amox for metronidazole
11
Q
NSAIDS
A
- non selective NSAIDS=higher risk
- treatment: at least 4 weeks with PPI (daily)
- prevention: switch to Tylenol, Add PPI to NSAID, add misopristol to NSAID, use cox 2 selective NSAID
12
Q
SRMD d/t critical illness
A
- risk factors:
- major (only need 1): respiratory failure (vent for at least 48 hrs), coagulopathy
- minor (need 2): sepsis, hypotensive/requires pressors, hx of GI bled, use of high dose steroids
- Stress ulcer prophylaxis: continue until risk factors are gone
- H2RA (zantac) -1st line
- PPIs (inc infection risk)
13
Q
Zollnger ellison syndrome
A
- gastron producing tumor
- diarrhea common symp
- PPI q8-12 hrs
14
Q
Upper GI bleeding
A
- Suspect in aematemesis, melena, NSAID users, hx of PUD
- Present with: epigastric pain or asymptomatic
- inc HR, dec BP, in HGb/Hct
- need IV NS/LR (bolus)
- Restore blood loss
- Supplemental oxygen
- revere anticoagulation
15
Q
Endoscopic management
A
- local target therapies
- epinephrine, targeted contact thermal therapy
- if they don’t undergo then 50% re-bleed rate
