PUD

Question 1

Peptic Ulcer Disease

Answer 1

• Burning epigastric pain exacerbated by fasting and improved with meals
• both gastric and duodenal ulcers (breaks in mucosal surface with depth to the submucosa)

Question 2

PUD Risk Factors

Answer 2

-Helicobacter pylori and NSAIDs are the most common risk factors for PUD

H PYLORI and NSAIDS

-Additional risk factors: chronic obstructive lung disease (2.34), chronic renal insufficiency, current tobacco use, former tobacco use, older age, three or more doctor visits in a year, coronary heart disease, former alcohol use, African-American race, obesity, and diabetes . The mechanisms by which some of these risk factors lead to ulcer disease

Question 3

PUD Smoking

Answer 3

Cigarette smoking has been implicated in the pathogenesis of PUD. Not only have smokers been found to have ulcers more frequently than do nonsmokers, but smoking appears to decrease healing rates, impair response to therapy, and increase ulcer-related complications such as perforation

Question 4

PUD presentation

Answer 4

Epigastric pain described as a burning or gnawing discomfort can be present in both DU and GU. The discomfort is also described as an ill-defined, aching sensation or as hunger pain. The typical pain pattern in DU occurs 90 minutes to 3 hours after a meal and is frequently relieved by antacids or food. Pain that awakes the patient from sleep (between midnight and 3 A.M.) is the most discriminating symptom, with two-thirds of DU patients describing this complaint

Question 5

PUD Complications

Answer 5

GI BLEED

-Most common
PERFORATION

-Penetration is a form of perforation in which the ulcer bed tunnels into an adjacent organ. DUs tend to penetrate posteriorly into the pancreas, leading to pancreatitis, whereas GUs tend to penetrate into the left hepatic lobe. Gastrocolic fistulas associated with GUs have also been described.
GASTRIC OUTLET OBSTRUCTION

Question 6

PUD DX

Answer 6

• Barium studies of the proximal GI tract
• Test for Hpylori

-Endoscopy provides the most sensitive and specific approach for examining the upper GI tract

- Screening for aspirin or NSAIDs (blood or urine) may also be necessary in refractory H. pylori–negative PUD patients.

Question 7

HPylori Testing

Answer 7

Three types of studies routinely used include serologic testing, the 13C- or 14C-urea breath test, and the fecal H. pylori (Hp) antigen test.

Question 8

PUD Treatment

Answer 8

• eradication of H. pylori and therapy/prevention of NSAID-induced disease is the mainstay of treatment.
• Meds: H2 Receptor Antagonists

Four of these agents are presently available (cimetidine, ranitidine, famotidine, and nizatidine), and their

PPI Omeprazole, esomeprazole, lansoprazole, rabeprazole, and pantoprazole

CYTOPROTECTIVE AGENTSSucralfate

Question 9

Hpylori tx

Answer 9

-Combination therapy for 14 days provides the greatest efficacy

The combination of bismuth, metronidazole, and tetracycline was the first triple regimen found effective against H. pylori.

The agents used with the greatest frequency include amoxicillin, metronidazole, tetracycline, clarithromycin, and bismuth compounds.

Quadruple therapy (Table 348-4), where clarithromycin is substituted for metronidazole (or vice versa), should be the next step. IF triple therapy dint work

Question 10

Gastric Ulcer Presentation

Answer 10

Pain NOT relieved by food, midline, left of midline

epigastric pain 1-3 hours after eating

nocturnal pain

heartburn

Question 11

Duodenal Ulcer

Answer 11

Pian reliereved by anatacids or food

pain on palpation 1 inch or farther to the RIGHT of midline