PUD

Question 1

What is the most common cause of chronic recurrent dyspepsia?

Answer 1

Non-ulcer dyspepsia (Functional dyspepsia) >50%

Other causes include gastroesophageal reflux disease (GERD) - 20%, Peptic ulcer disease <20%, Gastritis (NSAID, steroids, antibiotics), and Gastric carcinoma (<2%).

Question 2

What are the risk factors for ulcer complications in NSAID users?

Answer 2

• History of previous uncomplicated ulcer
• History of previous complicated ulcer
• Advanced age (> 60 years)
• Concomitant use of other NSAIDs, corticosteroids, anti-platelets, anticoagulants
• Significant cardiovascular disability

These factors significantly increase the risk of developing complications from NSAID use.

Question 3

What are the endoscopic findings in NSAID gastropathy?

Answer 3

• Subepithelial petechial bleeds
• Petechiae
• Erosions
• NSAID induced antral erosive gastritis with multiple exudates

These findings indicate damage to the gastric mucosa due to NSAID use.

Question 4

What is the risk of developing an endoscopic ulcer after taking oral NSAIDs for at least 2 months?

Answer 4

1 in 5

The risks of symptomatic ulcers and bleeding ulcers are about 1 in 70 and 1 in 150, respectively.

Question 5

What is the most common mucosal insult leading to Peptic Ulcer Disease (PUD)?

Answer 5

H. pylori and NSAIDs

Other uncommon causes include hypersecretion of gastric acid and various viral infections.

Question 6

What is the primary method for diagnosing H. pylori infection?

Answer 6

Urea breath test

This test involves the patient ingesting carbon-labeled urea, which is hydrolyzed by H. pylori, and the resulting CO2 is quantified.

Question 7

What are the cardinal symptoms of Peptic Ulcer Disease?

Answer 7

• Nocturnal epigastric pain
• Pain relieved by food
• Vomiting

These symptoms can vary based on the type of ulcer (gastric or duodenal).

Question 8

Fill in the blank: The typical age range for duodenal ulcers is ______.

Answer 8

> 25-75 years

Duodenal ulcers are more common in males and are often associated with H. pylori.

Question 9

What are the complications associated with Peptic Ulcer Disease (PUD)?

Answer 9

• Hemorrhage
• Penetration
• Perforation
• Gastric outlet obstruction
• Perioduodenal abscess
• Malignancy (GU)?

These complications can lead to significant morbidity and mortality.

Question 10

True or False: Most patients with gastric ulcers have high gastric acid secretion.

Answer 10

False

Most patients with gastric ulcers have normal-to-low acid secretion.

Question 11

What lifestyle factor is linked to decreased healing rates and increased ulcer-related complications?

Answer 11

Smoking

Smoking negatively impacts mucosal defense mechanisms and bicarbonate production.

Question 12

What is the goal of therapy directed at Peptic Ulcer Disease?

Answer 12

• Eradication of H. pylori infection
• Relief of pain
• Ulcer healing
• Recurrence prevention
• Prevention of long-term complications
• Cure

Therapy focuses on enhancing host defenses or eliminating aggressive factors.

Question 13

What is the peak age range for gastric ulcers?

Answer 13

55-65 years

H. pylori and NSAIDs are major risk factors for gastric ulcers.

Question 14

What are the objectives in understanding Peptic Ulcer Disease?

Answer 14

• Differentiate between acid peptic disease and PUD
• Understand the pathogenesis of PUD
• Identify the role of dyspepsia in PUD evaluation
• Identify treatment strategies for H. pylori and NSAID-associated PUD
• Understand treatment of PUD
• Identify complications of PUD

These objectives guide clinical practice and research in gastrointestinal health.

Question 15

What is the incidence rate of peptic ulcer bleeding in Europe?

Answer 15

19.4–79.0 cases per 100,000 individuals/year

This statistic highlights the prevalence of peptic ulcer bleeding in the European population.

Question 16

What is the average 30-day mortality rate for peptic ulcer bleeding?

Answer 16

8.7%

This mortality rate indicates the severity of peptic ulcer bleeding and its impact on patient outcomes.

Question 17

What is the estimated annual cost of peptic ulcer bleeding to employers and healthcare providers in the USA?

Answer 17

$5.7 billion

This figure reflects the economic burden of peptic ulcer bleeding on the healthcare system.

Question 18

What percentage of re-bleeds occurs within the first 7 days after initial bleeding?

Answer 18

90%

This statistic underscores the critical period for monitoring patients after an initial episode of peptic ulcer bleeding.

Question 19

What are the components of the standard treatment regimen for H. pylori infection?

Answer 19

• Omeprazole 20 mg BID + Clarithromycin 500 mg BID + Amoxicillin 1 g BID for 10/14 days
• Lansoprazole 30 mg BID + Clarithromycin 500 mg BID + Amoxicillin 1 g BID for 10/14 days

These regimens are FDA-approved for treating H. pylori infection, which is a common cause of peptic ulcers.

Question 20

What are the six steps in the protocol for managing peptic ulcer bleeding?

Answer 20

• Rapid assessment
• Resuscitation
• Stabilization
• Diagnosis
• Treatment
• Prevention of recurrence

These steps are crucial for effectively managing patients with peptic ulcer bleeding.

Question 21

What does Grade Ia in the Forrest classification of peptic ulcer bleeding indicate?

Answer 21

Spurting haemorrhage

This classification helps in assessing the severity of bleeding and guiding treatment decisions.

Question 22

What does Grade III in the Forrest classification of peptic ulcer bleeding indicate?

Answer 22

Clean ulcer base

This grade suggests no active bleeding and may influence management strategies.

Question 23

Fill in the blank: The initial management of peptic ulcer bleeding includes _______.

Answer 23

fluid replacement, prompt endoscopy, surgery if needed

These interventions are aimed at stabilizing the patient and controlling the bleeding.