PUD Flashcards
Which of the following is the most common cause of peptic ulcer disease?
A. Excessive alcohol consumption
B. Smoking
C. H. pylori infection
D. NSAID use
C. H. pylori infection
Which of the following medications is most associated with the development of peptic ulcers?
A. Paracetamol
B. NSAIDs
C. Statins
D. Antihistamines
B. NSAIDs
Which statement is TRUE regarding duodenal ulcers?
A. Pain is relieved by food
B. Pain is worsened by food
C. They are more common in woman
A. Pain is relieved by food
What is the first-line pharmacological treatment for PUD associated with H. pylori infection?
A. Antacids
B. Triple therapy (PPI + 2 antibiotics)
C. H2 receptor antagonists
D. Sucralfate
B. Triple therapy (PPI + 2 antibiotics)
- clarithromycin 500mg bd + amoxicillin 1g bd
or
-metronidazole 400mg bd + clarithromycin 500mg bd
Which of the following is an alarm symptom for peptic ulcer disease?
A. Mild nausea
B. Occasional bloating
C. Hematemesis
D. Epigastric pain relieved by eating
C. Hematemesis
Which diagnostic method is considered the gold standard for diagnosing PUD?
A. Barium swallow
B. Urea breath test
C. Endoscopy
D. Stool antigen test
Answer: C. Endoscopy
Describe the mechanism by which NSAIDs contribute to the formation of peptic ulcers.
NSAIDs inhibit the enzyme cyclooxygenase (COX), which is responsible for prostaglandin synthesis. Prostaglandins help protect the stomach lining by stimulating mucus and bicarbonate production and maintaining adequate blood flow. Without these protective prostaglandins, the gastric mucosa becomes vulnerable to acid, leading to ulcer formation.
List four common symptoms of peptic ulcer disease.
Epigastric pain (burning or gnawing)
Bloating
Nausea and vomiting
Weight loss
What is the role of proton pump inhibitors (PPIs) in the treatment of PUD?
PPIs reduce gastric acid secretion by inhibiting the hydrogen-potassium ATPase (proton pump) in gastric parietal cells. This reduction in acidity promotes healing of ulcers and provides symptomatic relief.
Identify two non-pharmacological interventions for managing peptic ulcer disease.
Smoking cessation
Avoidance of alcohol and NSAIDs
What is the primary difference in the timing of pain between gastric ulcers and duodenal ulcers?
In gastric ulcers, pain typically worsens with eating, while in duodenal ulcers, pain improves with eating and often returns a few hours after meals.
Discuss the role of Helicobacter pylori in the pathogenesis of peptic ulcer disease. Include the mechanisms by which it leads to mucosal damage and its diagnostic and treatment approaches.
H. pylori is a Gram-negative bacterium that plays a critical role in the development of peptic ulcers by colonizing the stomach lining and disrupting the mucosal defense mechanisms. It produces urease, which converts urea into ammonia and neutralizes stomach acid, allowing the bacteria to survive. H. pylori also triggers an inflammatory response, leading to the release of cytokines that damage the mucosal barrier. This results in increased vulnerability to gastric acid, causing ulcers.
Diagnostic methods include the urea breath test, stool antigen test, serology, and biopsy during endoscopy. Treatment involves triple therapy, which combines a PPI (e.g., omeprazole) with two antibiotics (e.g., clarithromycin and amoxicillin or metronidazole). Quadruple therapy, including bismuth, is used in areas with high clarithromycin resistance.
Compare and contrast the etiology, clinical presentation, and complications of gastric ulcers and duodenal ulcers.
Etiology: Gastric ulcers are commonly associated with NSAID use and H. pylori infection, while duodenal ulcers are more strongly associated with H. pylori infection.
Clinical Presentation: In gastric ulcers, pain typically worsens after meals, leading to weight loss as patients avoid eating. Duodenal ulcer pain improves with eating but returns a few hours later, often causing patients to eat more frequently to alleviate discomfort.
Complications: Both types can lead to complications such as bleeding, perforation, and obstruction. However, gastric ulcers have a higher risk of malignant transformation into gastric cancer, while duodenal ulcers are rarely malignant.
Explain the pharmacological management of NSAID-induced peptic ulcers, and describe strategies for preventing ulcers in patients requiring chronic NSAID therapy.
NSAID-induced peptic ulcers are treated primarily with proton pump inhibitors (PPIs) to reduce acid secretion and promote healing. H2-receptor antagonists (e.g., ranitidine) may be used as an alternative in mild cases. In addition to stopping NSAIDs if possible, patients may be prescribed misoprostol, a prostaglandin analog, to protect the stomach lining from the erosive effects of NSAIDs. Sucralfate can also be used as a cytoprotective agent, forming a barrier over the ulcer.
Prevention includes co-prescribing a PPI or misoprostol for patients who require chronic NSAID therapy, especially those at high risk (e.g., older adults, those with a history of ulcers). Using the lowest effective NSAID dose for the shortest duration and considering alternative pain management options, such as acetaminophen, are also recommended strategies for preventing ulcers.
