PUD

Question 1

Pathogenesis

MCC of gastric ulcers

Typical location
Gastric
Duodenal

Answer 1

Gastroduodenal mucosa is under constant assault

H pylori, NSAIDs

Fundus/antrum, normal rate of basal acid secretion

Near pylorus, inc rates of basal acid secretion

Question 2

H pylori mechanism resulting in ulcer formation

H pylori effect on acid secretion in antrum
Body

Answer 2

disrupt normal gastric acid secretion, stimulate local immune response, impairs normal mucosal defense

Antrum- inc gastric acid secretion
Body- normal/low secretion

Question 3

Chronic infection with H pylori

Inc acid production leads to

Urease activity

Answer 3

inc gastrin, low somatostatin- stimulates parietal cels to release acid

Metaplasia of duodenal mucosa, making it susceptible to injury

Damages epithelial cells, stimulates inflammatory cells

Question 4

H pylori and host response

Results in accumulation of

H pylori survivs via

Answer 4

Th1 mediated- releasing inflammatory cytokines (IL8, INFG, TNFA)

Leukocytes/PMNs

catalase

Question 5

COX 1 in gastric mucosa

PG effect

Answer 5

Produces prostaglandins

stimulate pithelial cells to secrete mucus/bicarb/phospholipids
Vasodilation
epithelial cell migration to surface

Question 6

Aspirin effect

Gastrinoma

Answer 6

inhibit gastric PG synthesis

ie ZE syndrome
stimulates gastrin sec
inc gastric acid, and histamine
cannot be neutralized by pancreatic bicarb
result in secretory diarrhea

Question 7

PUD CM

Physical exam

Guarding may indicate

Answer 7

dyspepsia
epigastric pain, worse after eating/middle of night
Vomitting, WL, dark stool/vomit

Epigastric tenderness

Perforation

Question 8

Most likely to perforate

Gastric ulcers

Gastric outlet obstruction

Answer 8

Duodenal ulcers- occur along posterior wall into pancreas (lead to pancreatitis)

antrum/body, penetrate into liver

pyloric channel/duodenal uclers
Gastric retention, satiety, anorexia, pain after eating

Question 9

Dx of PUD

Ulcers should be

Lab studies may indicate

Elevated fasting gastrin level greater than 10x ULN

Answer 9

Upper endoscopy, with biopsy

biopsied

Fe def anemia

indicates gastrinoma

Question 10

Peptic ulcer appearance

Answer 10

Punched out mucosal defects
Base is necrotic/smooth
Granulation tissue and scarring
May have PMNs

Question 11

Duration of PPI

Ucomplicated duodenal ulcer from H pylori

Complicated duodenal
Gastric

NSAID induced

Answer 11

Uncom- 14 days

Comp D- 4-8 weeks

Comp G- 8-12 wks

N- PPI for 8 weeks