(PUD)Peptic Ulcer Disease

Question 1

Peptic ulcers are deep mucosal lesions that disrupt the ___ layer of the gastric or duodenal wall

Answer 1

muscularis mucosa

Question 2

Gastric ulcers are generally located on the ___ of the stomach, and 90% of duodenal ulcers are found in the ___

Answer 2

lesser curvature, duodenal bulb

Question 3

Primary peptic ulcers are more often chronic and ___ in location

Answer 3

Duodenal

Question 4

Secondary peptic ulcers are more often acute and ___ in location

Answer 4

Gastric

Question 5

___ ulcers are most often associated with Helicobacter pylori infection

Answer 5

Primary ulcers

Question 6

By ___ of age, gastric acid secretion approximates adult values

Answer 6

3-4 yr

Question 7

Secondary peptic ulcers can result from…..

Answer 7

stress caused by sepsis, shock, or

an intracranial lesion (Cushing ulcer), or

in response to a severe burn injury (Curling ulcer)

Question 8

Zollinger-Ellison syndrome….

Answer 8

hypersecretory states

Question 9

Acid secreting cells in stomach…..

Answer 9

oxyntic cells

Question 10

Stomach has a pH of approximately….

Answer 10

0.8, whereas the pH of the stomach contents is 1-2.

Question 11

Stimulus for excessive acid secretion…….

Answer 11

A large parietal cell mass,
hypersecretion by antral G cells, and
increased vagal tone, resulting in increased or sustained acid secretion in response to meals and increased secretion during the night.

The secretagogues that promote gastric acid production include acetylcholine released by the vagus nerve, histamine secreted by enterochromaffin cells, and gastrin released by the G cells of the antrum.

Question 12

How common is hematemesis or Malena in PUD…..

Answer 12

Reported in up to half of the patients

Question 13

Initial presentation of PUD in neonatal period..

Answer 13

Perforation

Question 14

The classical symptoms of peptic ulceration…

Answer 14

Epigastric pain alleviated by the ingestion of food, is present only in a minority of children

Question 15

In a child with a normal diet for age, iron deficiency anemia may suggest …….reason

Answer 15

Peptic ulceration.

Question 16

Other gastric causes of iron deficiency anemia…..

Answer 16

autoimmune gastritis,
gastric hyperplasia, and
possible Jervell and
Lange-Nielson syndrome (KCNQ1 mutations).

Question 17

————-is the method of choice to establish the diagnosis of peptic ulcer disease

Answer 17

Esophagogastroduodenoscopy

Question 18

About H. Pylori……

Answer 18

H. pylori is a Gram-negative, S-shaped rod that produces urease, catalase, and oxidase, which might play a role in the pathogenesis of peptic ulcer disease

Question 19

The mechanism of acquisition and transmission of H. pylori ……

Answer 19

The most likely mode of transmission is fecal–oral or oral–oral.

Question 20

H. pylori can predispose children to a significantly increased risk of developing…..

Answer 20

duodenal ulcer,

gastric cancer such as adenocarcinoma, or

mucosa-associated lymphoid tissue lymphomas.

Question 21

Extragastric manifestations of H. pylori infection….

Answer 21

Anemia,
idiopathic thrombocytopenic purpura,
short stature, and
sudden infant death syndrome (SIDS)

Question 22

The diagnosis of H. pylori infection…….

Answer 22

histologically by demonstrating the organism in the biopsy specimens

Question 23

Eradication can be tested with the……..

Answer 23

13C-urea breath (13C-UBT) test or stool antigen test.

Question 24

Triple regimen therapy for H. PYLORI…..

Answer 24

Amoxicillin+Clarithromycin+PPI

Amoxicillin+Metronidazole+PPI

Clarithromycin+Metronidazole+PPI.

Question 25

Mechanism for drug induced PUD…..

Answer 25

NSAIDs produce mucosal injury by direct local irritation and by inhibiting cyclooxygenase (COX) and prostaglandin formation

Question 26

STRESS” ULCERATION………

Answer 26

Stress ulceration usually occurs within 24 hr of onset of a critical illness in which physiologic stress is present.

In many cases, the patients bleed from gastric erosions, rather than ulcers.

Approximately 25% of the critically ill children in a pediatric intensive care unit have macroscopic evidence of gastric bleeding

Question 27

Patients with suspected peptic ulcer hemorrhage should receive high-dose……….?

Answer 27

intravenous (IV) PPI therapy, which lowers the risk of rebleeding

Question 28

The reason behind using octreotide

Answer 28

Which lowers splanchnic blood flow and gastric acid production

Question 29

Methods to achieve the hemostasis …

Answer 29

mechanical devices (clipping),

injection therapy (diluted epinephrine 1:10,000), and

thermal therapy (heater probe).

Question 30

The first-line drugs for the treatment of gastritis and peptic ulcer disease in children……..

Answer 30

PPIs and H2 receptor antagonists

PPIs are more potent in ulcer healing.

Question 31

Long-term PPI therapy may result in…….

Answer 31

Hypomagnesemia and 
the risk of QT prolongation, 
as well as vitamin B12 and 
iron deficiencies and 
small bowel bacterial overgrowth

Question 32

The sequential treatment regimen ….

Answer 32

10-day treatment consisting of a PPI and amoxicillin (both twice daily) administered for the first 5 days

followed by triple therapy consisting of a PPI, clarithromycin, and metronidazole for the remaining 5 days.

Question 33

Zollinger-Ellison syndrome is a rare syndrome characterized by

Answer 33

Refractory, severe peptic ulcer disease caused by gastric hypersecretion due to the autonomous secretion of gastrin by a neuroendocrine tumor, a gastrinoma.

Question 34

ZES…..

Answer 34

The diagnosis is suspected by the presence of recurrent, multiple, or atypically located ulcers.

More than 98% of patients have elevated fasting gastrin levels

Question 35

Associated conditions wit ZES….

Answer 35

ZollingerEllison syndrome is common in patients with multiple endocrine neoplasia 1 and rare with neurofibromatosis and tuberous sclerosis