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Clinical Decision Making Exam 1 > PUD Case > Flashcards

PUD Case Flashcards

1
Q

major independent lifestyle rf for symptomatic and asymptomatic PUD

A

smoking

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2
Q

more than __ cigarettes/day increases risk of perforated peptic ulcer threefold

A

15

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3
Q

__ in high concentrations damages the gastric mucosal barrier

A

etoh

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4
Q

epigastric pain w. PUD is worse after

A

eating

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5
Q

BUN:Cr ratio in PUD is often

A

>30:1

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6
Q

why is BUN:Cr ratio elevated in PUD

A

blood is absorbed as it passes through small bowel → decreased renal perfusion

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7
Q

what do higher BUN:Cr ratios indicate

A

higher likelihood of bleeding from UGI source

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8
Q

common EGD findings of PUD

A

oozing gastric hemorrhage

nonbleeding visible vessel

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9
Q

ddx for UGIB

A

PUD

esophagitis

angiodysplasia

portal HTN

mallory-weiss syndrome

UGI tumor

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10
Q

4 rf for PUD

A

h.pylori

nsaids

physiologic stress

excess gastric acid

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11
Q

etiology of NSAID induced PUD

A

prostaglandin/COX-1 inhibition → mucosal damage

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12
Q

abnormal dilated tortuous vessel in UGI

A

angiodysplasia

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13
Q

3 rf for angiodysplasia

A

renal dz

aortic stenosis

hereditary

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14
Q

peptic ulcers are defects in __ mucosa (2)

that extend thru the __

and persist dt __

A

gastric or duodenal

muscularis mucosa

acidic gastric acid

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15
Q

NSAIDs are associated w. __ ulcers

and increased risk of __

A

refractory

complications

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16
Q

all pt’s w. PUD should undergo __ testing

A

H.pylori

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17
Q

when can h.pylori testing be done

A

bx during EGD

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18
Q

t/f: if actively bleeding, a negative bx rules out H.pylori

A

F!

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19
Q

if h.pylori test is negative in active bleeding pt, what 2 tests can be used to confirm negative dx

A

urea breath

stool antigen

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20
Q

ASAP tx for PUD (4)

A

2 large bore IVs - at least 16 g

NPO

bolus of 500-1000 cc of fluids

GI consult for EGD

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21
Q

transfusion threshold

A

Hgb 7

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22
Q

transfusion threshold for high risk PUD pt

A

< 8

23
Q

indication for high risk PUD pt

A

CAD

24
Q

other tx considerations for PUD

A

IV esomeprazole OR pantoprazole

stop NSAIDs

25
Q

dosing for esomeprazole or pantoprazole if pt is actively bleeding

A

80 mg

26
Q

if pt needs to stay on ASA, what reduces risk of ulcer complications/recurrence

A

maintenance PPI therapy →

omeprazole 20 mg

27
Q

continued tx for all PUD pt’s should include __ to facilitate healing

A

PPI → omeprazole 20-40 mg qd

28
Q

indications for complicated PUD (4)

A

bleeding

perforation

penetration

gastric outlet obstruction

29
Q

complicated PUD pt’s should get __ to facilitate healing

A

IV PPI

30
Q

t/f: PPIs cause stronger acid suppression than H2 blockers and control sx faster and have higher healing rates

A

T!

31
Q

__ pH levels stabilize clots and heal NSAID related ulcers more effectively than H2 blockers

A

higher

32
Q

T/F: combining PPIs and H2 blockers is beneficial to PUD pt’s

A

F!

33
Q

when can a pt w. an actively bleeding ulcer be switched from IV to PO PPI

A

72 hours after endoscopy

34
Q

dose and duration for PO PPI for pt who has been switched from IV to PO

A

omeprazole 20 mg x 4-12 weeks

35
Q

__ can heal duodenal ulcers but are not recommended for peptic ulcers (2)

A

antacids

sucralfate

36
Q

2 lifestyle recommendations for PUD

A

stop smoking

limit etoh to 1 drink/day

37
Q

2 tools to calculate PUD risk and outpt management

A

glasgow blatchford score (GBS)

rockfall score

38
Q

when is GBS calculated

A

at patient presentation

doesn’t need EGD

39
Q

when is rockfall calculated

A

after endoscopy

40
Q

what factors does GBS use (8)

A

BUN

Hgb

SBP

pulse

presence of melena

syncope

hepatic dz

cardiac failure

41
Q

what factors does rockfall use (5)

A

age

presence of shock

comorbidity

dx

endoscopy results

42
Q

indications for d.c post endoscopy (3)

A

no comorbidities

stable vitals

normal Hgb

43
Q

2 indications for somatostatin/octreotide

A

endoscopy not available

help stabilize pt before definitive therapy can be done

44
Q

how do somatostatins/octreotide work

A

reduce splanchnic blood flow

inhibit gastric acid secretion

+/- protective effect on gastric cells

45
Q

what 2 therapies are much more effective for PUD than somatostatin/octreotide

A

PPI

endoscopy

46
Q

__ can predict recurrent peptic ulcer hemorrhage

A

EGD findings

47
Q

classification that is used to objectify EGD findings for PUD

A

Forrest

48
Q

in forrest classification, what counts as a stigmata of recent hemorrhage

A

anything other than a clean ulcer base

49
Q

what are the forrest classifications (6)

A

spurting hemorrhage

oozing hemorrhage

nonbleeding visible vessel

adherent clot

flat pigmented spot

clean ulcer base

50
Q

3 EGD tx for PUD

A

thermal coagulation therapy

hemostatic clips

+/- injection therapy

51
Q

what is EGD injection therapy

A

epinephrine

52
Q

who determines risk for rebleeding in PUD pt

A

GI

53
Q

generally, when can you restart anticoagulation/antiplatelet therapy (ASA) after PUD tx

A

1 day following endoscopic hemostasis

54
Q

t/f: data shows that restarting ASA for secondary prevention reduces mortality risk in pt’s w. CV or cerebrovascular dz w. bleeding from PUD

A

T!

Clinical Decision Making Exam 1 (22 decks)

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