PUD

Question 1

Causes of PUD

Answer 1

Most common causes: H. Pylori and NSAID use

Less common causes: Crohn’s, other viral illnesses, Zollinger-Ellison syndrome (excess gastric acid secretion), malignancy, stress (acute illness, burns), vascular insufficiency, chemorads

Question 1

Define PUD

Answer 1

Illness where ulcers (open sores) develop in the lining of the stomach or small intestine

Question 2

risk factors for PUD

Answer 2

Frequent NSAID use
Previous PUD
H. Pylori infection
FH of PUD

Question 3

Pathophys of PUD

Answer 3

Imbalance of mucosal protective abilities and gastric acid secretion

H. Pylori infection ➔ secretes urease which protects organism from acidic environment, releases toxins to damage lining, has flagella so virus is mobile to move towards epithelium, impairs secretion of bicarb

NSAIDs ➔ impairs the production of prostaglandins which decreases gastric mucus and bicarbonate production and decreases mucosal blood flow (which normally helps to remove excess H+ and support proper mucosal protection)

Question 4

Key S/S of PUD and pathphys of S/S

Answer 4

erosion of blood vessels in the stomach
- coffee ground emesis ➔ digested blood by HCl being vomited
- melena ➔ black tarry stool because blood has been digested

erosion of blood vessels in the esophagus
- hematemesis

irritation of somatic innervation
- epigastric pain
- nausea
- dyspepsia ➔ upset stomach

perforation of ulcer
- referred pain to shoulder

Question 5

how to tell between gastric vs duodenal ulcer?

Answer 5

Timing of pain
gastric - pain shortly after eating
duodenal - pain 2-3 hours after eating or pain without food in stomach

Question 6

common nonspecific s/s for PUD

Answer 6

epigastric pain, bloating, abdominal fullness, nausea, vomiting, hematemesis, melena, wt loss/gain

Question 7

Red flag s/s for PUD

Answer 7

unintentional wt loss, overt GI bleeding (frank blood, hemodynamic instability), FH of GI malignancy, iron deficiency anemia (sign of blood loss), recurrent emesis, progressive dysphagia (swallowing)

Question 8

Ix for PUD

Answer 8

1. EGD - upper endoscopy ➔ visualize the stomach and small intestine for ulcers
   - barium swallow test if EGD contraindicated (e.g., possible perforation
2. H. Pylori testing
   - serologic testing
   - stool culture
   - Antibody testing
   - urea breath test
   - urine test
3. bloodwork - investigate presenting s/s and ddx
   - CBC, INR, lipase, AST/ALT, bilirubin, BUN, creatinine
4. imaging ➔ CT ➔ would mainly help in the case of cx of PUD like perforation
   - also useful when EGD is contraindicated and nothing can be tolerated orally

Question 9

Tx for PUD

Answer 9

Anti-secretory medications
- PPIs and H2-receptor antagonists
- calcium supplements with PPI because PPI makes bone fragile

Prostaglandin analogs ➔ specifically for NSAID etiology
Abx ➔ specifically for H. Pylori etiology

Consider surgery for ulcers that do not get better with medicinal treatment or active bleeding/perforation

Question 10

ddx for PUD

Answer 10

Gastritis
Crohn’s
Malignancy
Biliary colic ➔ because of pain with eating
Any biliary/gallbladder conditions