PUD and gastric cancer Flashcards
two main causes of peptic ulcer disease
- H. pylori infection
- NSAID use
How does Helicobacter pylori cause peptic ulcer disease
- disrupts protective properties by decreasing gastric mucus and mucosal bicarbonate secretion
H. pylori primarily affects what age group?
- children
- becomes chronic unless tx with abx
peptic ulcers extend into what layer of GI
muscularis mucosa
clinical presentation
- burning/gnawing pain relieved by meals
- symptoms 2-5 hrs after eating
- symptoms occur without food as buffer (11pm-2am)
duodenal ulcers
clinical presentation
- asymptomatic
- epigastric pain
- nausea
- belching
- epigastric fullness
- bloating
- anorexia
peptic ulcer disease
clinical presentation
- burning/gnawing pain aggravated by meals
- symptoms shortly after a meal/within 30 minutes
- gastric ulcers
- food causes G cells to secrete gastrin in stomach -> HCl
what are alarm symptoms when evaluating for PUD and need gastroenterology referral
- bleeding/anemia
- early satiety
- unexplained weight loss
- progressive dysphagia
- recurrent vomiting
- fhx GI cancer
What is the most common complication of peptic ulcer disease
- hemorrhage (5-20%)
how is peptic ulcer disease with hemorrhage treated
- stabilization: IV fluids, PRBC
- PPI (IV)
- EGD: upper endoscopy
patient has a h/o peptic ulcer disease and presents with sudden, severe diffuse or epigastric abdominal pain, what is your primary concern? What modalities could you use to diagnose
-
acute perforation (2-10%)
- seen most commonly in elderly + chronic NSAID use
- tx: urgent surgical therapy
- X-ray, CT scan, UGI with gastrografin
In peptic ulcer disease, a complication is an ulcer erodes through walls into adjacent organs. what is the most often site of perforation
- pancreas
- acute onset of pancreatitis, cholangitis, or diarrhea (undigested food)
If a patient with peptic ulcer disease presents with early satiety, bloating, N/V, epigastric discomfort, and weight loss, what is your primary concern?
- gastric outlet obstruction (5%)
- caused by scarring or inflammation in pyloric channel
What is a succussion splash? What conditions can cause this?
- sloshing sound heard through the stethoscope/naked air when patient’s abd is shaken by holding each side of the pelvis
- reflects presence of gas and fluid in an obstructed organ
- gastric outlet obstruction
If you diagnose a patient who has no alarm symptoms with peptic ulcer disease, what is the managment
- test and treat for H. pylori
- if patient is under 55 yo
What are the three ways to diagnose H. Pylori? which is the gold standard
- urea breath test
- fecal antigen test
- biopsy via endoscopy: gold standard
How does the urea breath testing work
- pt drinks a solution with radioactively labeled urea
- urease produced by H. pylori splits urea into CO2 and NH3
- measure labeled CO2 in breath
biopsy of stomach to test for H. pylori is taken via what mechanism
- endoscopy
- +/- rapid urease testing
- fyi: biopsy of mucosa is placed into a medium containing urea and an indicator such as phenol red. The urease produced by H. pylori hydrolyzes urea to ammonia, which raises the pH of the medium, and changes the color of the specimen from yellow (NEGATIVE) to red (POSITIVE)
Patient is under 55 yo is diagnosed with PUD. No alarm symptoms are present. What tests will you order
- fecal antigen test OR
- urea breath test
Patient who is over 55 yo is diagnosed with PUD. +/- alarm symptoms are present. What tests will you order
- endoscopy-> biopsy -> rapid urease test
- test of choice for H.pylori
- visualization, hemostasis, and biopsy
- pt must be off abx and PPIs
- test of choice for H.pylori
Managment of patients who are diagnosed with PUD but who take NSAIDs
- discontinue NSAID use
- treat with PPI x 8-12 weeks
- patients that need to continue with NSAIDs or ASA
- consider maintence therapy with a PPI + NSAID/ASA
How is an uncomplicated duodenal ulcer tx
- treat H. pylori infection in found
- ensure eradication (UCT/fecal antigen test or biopsy)
treatment of complicated duodenal ulcer
- if bleeding ulcer: address bleeding and endoscope for theraputic intervention
- PPI x 4-8 weeks
- treat H. pylori infection if found
- ensure eradication (UCT/fecal antigen test or biopsy)
treatment of gastric ulcer
- PPI x 8-12 weeks
- repeat EGD to confirm healing
