PUD Flashcards
what are the areas that are exposed to acid and pepsin secretion ?
1- first part of the duodenum
2- lesser curvature of the stomach and pyloric antrum
3- lower oesophagus
4- meckel’s diverticulum
what are the three locations of ulcers associated with peptic ulcer disease ?
esophageal ulcer
gastric ulcer
duodenal ulcer
what are the 2 main pathologies associated with peptic ulcer disease ?
1- hyperacidity
2- decreased mucosal defense mechanism
what is zollinger ellison syndrome ?
increased gastric secretion due to gastrinoma, eventually causing peptic ulcers
associated with pancreatic cancer
what pathology is more important in the formation of gastric peptic ulcers ?
breakdown of mucosal defense
what is the main cause for the formation of peptic ulcers in the duodenum ?
h pylori gastritis acid production
what are the causes of formation of gastric ulcers ?
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
what is the presentation for gastric ulcers ?
1- localized epigastric pain , provoked by intake of food
2- nausea and vomiting
how is a diagnosis of gastric ulcers made ?
endoscopy
biopsy
radiography ( barium meal )
duodenal erosion vs duodenal ulcer ?
ulcers : usually small ulcers, which penetrate to the muscles
erosions : considered a superficial ulcer and it does not penetrate to the muscle
what are the causes of duodenal ulcer ?
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
what is the presentation of duodenal ulcers ?
pain in the upper abdomen which radiates to the back
happens mainly on an empty stomach and described as burning
relieved by food intake
what are the differentials for epigastric pain ?
PUD
gastritis
GERD
pancreatitis
gastric perforation
on average when ddoes the ressurence of gastric ulcers occur ?
within 2 years
on average when does the recurrence of duodenal ulcers occur ?
within 6-8 months after healing
what aree. the complications of h.pylori ?
duodenal ulcers
gastric ulcers
gastric adenocarcinoma
MALT lymphoma
what is the first line treatment for h.pylori ?
PPI
clarithromycin
Amoxicillin
Metronidazole
for 14 days
what is the alternative treatment for h pylori ?
PPI
levofloxacin
amoxicillin
what are the complications of peptic ulcer disease ?
haemorrhage
perforation
obstruction ( surgical emergency )
what is the presentation of a haemorrhage as a result of complicated peptic ulcer ?
if a small vein is perforated - vomiting dark material (hematemesis)
if an artery is penetrated - bleeding will be profuse
which complication is more common in patients with duodenal ulcers ?
perforation
what is the treatment for h pylori ?
medical : PPi , H2R antagonist, Antacids
h.pylori treatment
endoscopic treatment
surgical treatment
what is the management for bleeding peptic ulcers ?
resuscitate the patient the first
then endoscopic treatment :
1- injection
2- heater probe
3- clipping
if all failed surgery would be the answer
how is a diagnosis of delayed gastric emptying made ?
once the suspicion of mechanical obstruction has been ruled out then gastroparesis can be confirmed with scintigraphy
examples of NSAIDs ?
aspirin
naproxen
Ibuprofen
main alternative for NSAIDs ?
paracetamol
what is acute gastritis characterised by ?
acute inflammation of the gastric mucosa characterised by a neutrophil infiltrate
what is chronic gastritis characterised by ?
sustained inflammatory response to gastric mucosa characterized by the presence of plasma cells
what are the two types of atrophic gastritis ?
autoimmune
h pylori related gastritis
where does h pylori atrophic gastritis occur ?
mainly in the antrum
what are the findings on endoscopy of atrophic gastritis ?
mucosal and submucosal vessels are visible and without excessive distention with air
what are the non invasive methods for the diagnosis of H pylori ?
serological test
c urea breath test
stool antigen test
what are the invasive methods for h pylori diagnosis ?
biopsy urease test
histology
culture
where is the atrophy seen in autoimmune atrophic gastritis ?
fundus and corpus
what are the complications of atrophic gastritis ?
intestinal metaplasia
what is the pathology in autoimmune gastritis ?
destruction of the parietal cells
what is the most common cause of hemorrhagic gastritis ?
drug induced
what are the differentials of haemorrhagic gastritis ?
may be indistinguishable from telangiectasia
must be differentiated from gastric purpura due to thrombocytopenia
what are the causes of stress gastritis ?
severe trauma
hypotension
sepsis
major burns
renal or respiratory failure
what are the causes of rugal hyperplastic gastritis ?
menetrier’s disease
zollinger ellison syndrome
lymphoma
carcinoma
what viruses are associated with viral gastritis ?
EBV
CMV
when should testing to confirm eradication be done for patients being treated for h pylori ?
4 weeks later
