PUD and Gastritis

Question 1

What are the 3 primary causes of peptic ulcer dz?

Answer 1

H. Pylori
NSAID abuse
Stress-related Gastric mucosal damage (shock, hypertension)

Question 2

What are the major risk factors for developing PUD?

Answer 2

H. Pylori
NSAID use
gastric acid hypersecretion
alcohol
smoking
ischemia

Question 3

What tests can be used to determine the presence of gastritis?

Answer 3

EGD (esophogogastroduodenoscopy)

Question 4

What tests should be done to determine the presence of H. pylori infection and other causes of PUD? How can its eradication be confirmed?

Answer 4

EGD followed by biopsy
Stool antigen (before and after tx)
Antibody (before)
Urea breath test (before and after tx)

Question 5

What treatments are available for the eradication of H. pylori as well as treatment of symptomatic gastritis?

Answer 5

Helidac= Metronidazole
Tetracycline
Bismuth subsalicylate and H2 antagonist
Prevpac= Lansoprazole (PPI)
Biaxin (Clarithromycin
Amoxicillin

Question 6

What are the major causes of gastritis?

Answer 6

H. pylori, NSAID abuse, and Stress related gastric mucosal damage

Question 7

What are the 2 types of gastritis?

Answer 7

Type A (atrophic)
Type B (non-atrophic)

Question 8

Describe Type A Gastritis

Answer 8

Can be auto-immune vs multifocal
Less Common
Can be associated with pernicious anemia
Mainly involves fundus and body
Spares antrum
Can be but not commonly caused by H. pylori

Question 9

Describe Type B Gastritis

Answer 9

More common
Generally associated w/ H. pylori
Antral predominant
Can expand to involve entire stomach

Question 10

What type of vitamin deficiency can be caused by gastritis?

Answer 10

B12 deficiency (pernicious anemia) 
Bc if you don't make intrinsic factor, you cannot absorb B12

Question 11

What rare type of gastric cancer is associated with H. pylori infection that goes into remission with eradication of the organism?

Answer 11

MALT lymphoma (abnormal proliferation of B-lymphocytes)

Question 12

What is Zollinger-Ellison Syndrome?**

Answer 12

Characterized by elevated levels of gastrin (>1000pg/ml)

Produced by GASTRINOMAS frequently found in the pancreas or duodenum

Question 13

What is the best diagnostic tool for Zollinger Ellison?

Answer 13

SOMATOSTATIN-RECEPTOR SCINTIGRAPHY

Question 14

How is ZE treated?

Answer 14

Treat the tumor and then treat the ulcers by treating excess acid with lansoprazole (prevacid), omeprazole (prilosec), etc.