PUD

Question 1

what are the areas that are exposed to acid and pepsin secretion ?

Answer 1

1- first part of the duodenum
2- lesser curvature of the stomach and pyloric antrum
3- lower oesophagus
4- meckel’s diverticulum

Question 2

what are the three locations of ulcers associated with peptic ulcer disease ?

Answer 2

esophageal ulcer
gastric ulcer
duodenal ulcer

Question 3

what are the 2 main pathologies associated with peptic ulcer disease ?

Answer 3

1- hyperacidity
2- decreased mucosal defense mechanism

Question 4

what is zollinger ellison syndrome ?

Answer 4

increased gastric secretion due to gastrinoma, eventually causing peptic ulcers
associated with pancreatic cancer

Question 5

what pathology is more important in the formation of gastric peptic ulcers ?

Answer 5

breakdown of mucosal defense

Question 6

what is the main cause for the formation of peptic ulcers in the duodenum ?

Answer 6

h pylori gastritis acid production

Question 7

what are the causes of formation of gastric ulcers ?

Answer 7

1- h pylori infections
2- delayed gastric emptying (gastroparesis)
3- defective mucosal barrier
4- bile reflux into the stomach due to pyloric sphincter dysfunction
5- NSAIDS

Question 8

what is the presentation for gastric ulcers ?

Answer 8

1- localized epigastric pain , provoked by intake of food
2- nausea and vomiting

Question 9

how is a diagnosis of gastric ulcers made ?

Answer 9

endoscopy
biopsy
radiography ( barium meal )

Question 10

duodenal erosion vs duodenal ulcer ?

Answer 10

ulcers : usually small ulcers, which penetrate to the muscles
erosions : considered a superficial ulcer and it does not penetrate to the muscle

Question 11

what are the causes of duodenal ulcer ?

Answer 11

hypersecretion of gastric acid
increased number of parietal cells
increased sensitivity of parietal cells to gastrin
reduced gastrin inhibition
increased gastric emptying
reduced neutralizing capacity
infection with h.pylori

Question 12

what is the presentation of duodenal ulcers ?

Answer 12

pain in the upper abdomen which radiates to the back
happens mainly on an empty stomach and described as burning
relieved by food intake

Question 13

what are the differentials for epigastric pain ?

Answer 13

PUD
gastritis
GERD
pancreatitis
gastric perforation

Question 14

on average when ddoes the ressurence of gastric ulcers occur ?

Answer 14

within 2 years

Question 15

on average when does the recurrence of duodenal ulcers occur ?

Answer 15

within 6-8 months after healing

Question 16

what aree. the complications of h.pylori ?

Answer 16

duodenal ulcers
gastric ulcers
gastric adenocarcinoma
MALT lymphoma

Question 17

what is the first line treatment for h.pylori ?

Answer 17

PPI
clarithromycin
Amoxicillin
Metronidazole
for 14 days

Question 18

what is the alternative treatment for h pylori ?

Answer 18

PPI
levofloxacin
amoxicillin

Question 19

what are the complications of peptic ulcer disease ?

Answer 19

haemorrhage
perforation
obstruction ( surgical emergency )

Question 20

what is the presentation of a haemorrhage as a result of complicated peptic ulcer ?

Answer 20

if a small vein is perforated - vomiting dark material (hematemesis)
if an artery is penetrated - bleeding will be profuse

Question 21

which complication is more common in patients with duodenal ulcers ?

Answer 21

perforation

Question 22

what is the treatment for h pylori ?

Answer 22

medical : PPi , H2R antagonist, Antacids
h.pylori treatment
endoscopic treatment
surgical treatment

Question 23

what is the management for bleeding peptic ulcers ?

Answer 23

resuscitate the patient the first
then endoscopic treatment :
1- injection
2- heater probe
3- clipping

if all failed surgery would be the answer

Question 24

how is a diagnosis of delayed gastric emptying made ?

Answer 24

once the suspicion of mechanical obstruction has been ruled out then gastroparesis can be confirmed with scintigraphy

Question 25

examples of NSAIDs ?

Answer 25

aspirin
naproxen
Ibuprofen

Question 26

main alternative for NSAIDs ?

Answer 26

paracetamol

Question 27

what is acute gastritis characterised by ?

Answer 27

acute inflammation of the gastric mucosa characterised by a neutrophil infiltrate

Question 28

what is chronic gastritis characterised by ?

Answer 28

sustained inflammatory response to gastric mucosa characterized by the presence of plasma cells

Question 29

what are the two types of atrophic gastritis ?

Answer 29

autoimmune
h pylori related gastritis

Question 30

where does h pylori atrophic gastritis occur ?

Answer 30

mainly in the antrum

Question 31

what are the findings on endoscopy of atrophic gastritis ?

Answer 31

mucosal and submucosal vessels are visible and without excessive distention with air

Question 32

what are the non invasive methods for the diagnosis of H pylori ?

Answer 32

serological test
c urea breath test
stool antigen test

Question 33

what are the invasive methods for h pylori diagnosis ?

Answer 33

biopsy urease test
histology
culture

Question 34

where is the atrophy seen in autoimmune atrophic gastritis ?

Answer 34

fundus and corpus

Question 35

what are the complications of atrophic gastritis ?

Answer 35

intestinal metaplasia

Question 36

what is the pathology in autoimmune gastritis ?

Answer 36

destruction of the parietal cells

Question 37

what is the most common cause of hemorrhagic gastritis ?

Answer 37

drug induced

Question 38

what are the differentials of haemorrhagic gastritis ?

Answer 38

may be indistinguishable from telangiectasia
must be differentiated from gastric purpura due to thrombocytopenia

Question 39

what are the causes of stress gastritis ?

Answer 39

severe trauma
hypotension
sepsis
major burns
renal or respiratory failure

Question 40

what are the causes of rugal hyperplastic gastritis ?

Answer 40

menetrier’s disease
zollinger ellison syndrome
lymphoma
carcinoma

Question 41

what viruses are associated with viral gastritis ?

Answer 41

EBV
CMV

Question 42

when should testing to confirm eradication be done for patients being treated for h pylori ?

Answer 42

4 weeks later