PUD & gastritis Flashcards
differentiate PUD from gastritis & gastropathy
- Gastritis: precursor to PUD; hard to differentiate; inflammation associated w/ mucosal injury; symptoms jus like PUD
- PUD: mucosal defect in GI tract exposed to acid and pepsin secretion
- Gastropathy: epithelial cell damage and regeneration +/- inflammation; secondary to irritants
common causes of gastritis
H. pylori
NSAIDs, radiation, allergic, autoimmune, duodenitis
location of GU vs DU?
GU in antrum
DU in bulb
how do ulcers development
- buffered surface mucous layer with rapid epithelial turnover or tight junctions
- deficient protective prostagladins (less bicarb/mucous)
high risk vs low risk NSAIDs
- high risk: feldene/proxicam, ketorolac/toradol, indomethacin
- low risk: celebrex, under 1500mg/day ibuprofen, etc
who is at risk for NSAID induced PUD (3)
- prior hx of adverse GI event
- over 60 yo
- high dose NSAID + steroid or anticoag
differentiate DU from GU
- DU> GU
- DU always nonmalignant & feels better with eating (weight gain)
- GU is typically benign but can be malignant; feels worse after eating
ulcers in which location requires repeat endoscopy after acid suppression treatment & documentation & biopsy
gastric
describe sx of PUD and 3 associated sx
what is this condition
epigastric pain (burning or gnawing) around meals or at night that is relieved by antacids or vomiting
* dyspepsia, hematemesis or melena
where does NSAID vs h.pylori induced ulcers occur? which shows more severe bleeding?
- h. pylori is more in duodenum and superficial; less severe bleeding
- NSAIDs in deep and in stomach; more severe bleeding and sometimes asymptomatic
list 3 complications of PUD and which is most common?
bleeding: most common
gastric outlet obstruction
perforation: top cause of pneumoperitoneum
best initial diagnostic study for perforated peptic ulcer?
upright abdominal plain films
morphology of H. pylori
spiral gram - rod w/ flagella
secreates urease which converts urea to amonia
produves alkaline environment
diseases associated with PUD– increases risk (3) & hypersecretory ones (2)
- hypersecretory– gastrinoma (zollinger-ellison), MEN-1
- increased risk–cirrhosis, chronic pulm dz, renal fail
3 PE findings of PUD
- mild epigastric tenderness
- maybe melena/guaiac + stool
- peritonitis with perforation
5 diagnostic tools for H. pylori
- EGD w/ biopsy
- rapid urease
- urea breath test
- stool antigen
- serolofy
classic triad of sudden severe diffuse abdominal pain, tachycardia, abdominal regidity
hallmark of peptic ulcer perforation
test that you can do for H.pylori PUD for initial diagnosis + confirmation of eradication?
Urea Breath test
test that is good for initial diagnosis + confirmation of eradication of h.pylori (4 wks after tx); needs little prep
HpSA antigen test
which two H.pylori tests can have false negative with PPI, bismuth and abx
urea breath test
fecal antigen testing (hpsa)
test that can detect IgG antibodies but does NOT determine if its an active H. pylori infection
* useful for those who never got treated or symptomatic pt not using NSAIDs
serology
which meds should patients be off for stool and both urea based testing? (3)
PPI
abx
bismuth (pepto bismol, etc)
use antacids and H2 blockers if symptomatic
binds to ulcer base forming a protective coat and has anti-inflammatory and bactericidal properties’; can cause dark stools
bismuth subsalicylate (pepto bismol)
Selectively block H2 receptors on parietal cells reducing acid secretion
* Used primarily in non-H. Pylori ulcer dz for 6-8 wks
what class? what are SE?
H2 blockers
Cimetidine SE: confusion in elderly, impotence +/- gynecomastia, may alter levels of other drugs, may alter renal function requiring lower dose
Decreases gastric acid secretion by blocking parietal cell H/K ATP pump
* better for NSAID related PUD
* duration depends on location, etiology, complications
what class? SE?
PPI
SE: calcium malabsorption (achlorhydria); low Mg, infection and fracture risk
4 medical tx of non-h.pylori PUD
OTC neutralizers
H2 blockers
PPI
surgery
3 surgical options for PUD
Antrectomy with vagotomy
Truncal vagotomy w/ pyloroplasty
Highly selective vagotomy
how is H.pylori PUD treated?
- triple therapy x 14 days
- quadruple therapy
triple vs quad therapy
PPI + clarithromycin + amoxicillin (sub for metronidazole if PCN allergic)
OR
Bismuth + tetracycline + metronidazole + PPI
3 steps in treating NSAID-PUD
- discontinue NSAIDs if you can, if not reduce dose
- Sucralfate or Misoprostol
- prophylactic treatment
what is given prophylactically for NSAID-PUD and who gets it?
- for high risk ppl taking nonselective NSAIDs
- Misoprostol 200 mg 4x/day + Iansoprazole 15 or 30 mg daily
when do you do PPI IV?
complicated ulcers
tx duration for complicated DU vs GUvs NSAID induced?
- DU: PPI x 4-8wks
- GU: PPI x 8-12 wks until EGD confirms healing
- NSAID induced: PPI x 4-8wks
which type of ulcer requires surveillance?
GU requires it in 8-12 wks
only done in DU if sx persist
