PUD (Week 3 GI)

Question 1

What is PUD?

Answer 1

Acid in the digestive tract eats away at the inner surface of the stomach or small intestine creating painful open sores that may bleed. Your digestive tract is coated with a mucous layer that normally protects against acid.

Question 2

Prevalence of PUD

Answer 2

Affects 10% of world population
* biggest factor is hygiene and sanitation of water supply where H. pylori bacteria can get in

Question 3

Symptoms of PUD

Answer 3

• Acute abdominal pain → usually associated with intake of food/fluid
• Distension
• Melena Stools → stools are black due to “old blood”
• Hemataemesis (vomiting blood) → old clots (black) or fresh blood

Hemataemesis usually first sign

Pyschosocial factors affect symptom perception & reporting

Question 4

Where can PUD occur?

Answer 4

Can occur in any area that is exposed to gastric acid and pepsin
* Esophagus (lower) → rare but may occur with chronic untreated reflux or if you have GERD
* Gastric/ stomach (gastric acid and pepsin produced here) → ↓ mucosal blood flow generally due to poor nutrition
* duodenum (acids can leak in) → hypersecretion of acid in stomach leads overly acidic chyme

Food can also get stuck in ulcers and can cause bacterial infection

Question 5

Predisposing Risk Factors of PUD

Answer 5

• hygiene and sanitation of local water supply (BIGGEST)
• Poor nutrition
• Smoking (association not cause)
• Genetics (association not cause)
• Excessive alcohol intake
• Use of salicylates (aspirin) or NSAID’s (ibuprofen) (super high doses like 8-20/d)
• Helicobacter Pylori infection
• synergistic effect: NSAIDS and H. Pylori

Question 6

Helicobacter Pylori Bacteria

Answer 6

Found between gastric epithelial cells and mucosa which greatly increases risk of gastric & duodenal ulcer with 1/3 - 1/2 of world population having the bacteria. When toxins from bacteria are secreted:
* Inflammation
* tissue damage
* break in mucosa
* ulcer

Question 7

How is H. pylori infection determined?

Answer 7

Do a biopsy of the site and see if the bacteria is growing and can then treat with antibiotics

Question 8

How can H. Pylori risk be reduced

Answer 8

Target the water source

Question 9

Treatment for PUD

Answer 9

1. medication
2. diet
3. lifestyle
4. surgery

Question 10

medication treatment for PUD

Answer 10

H2 histamine receptor antagonists
* decrease stimulation of parietal cells (acid secreting cells)
* decreases H2 secretion
* e.g. cimetidine, omeprazole
* benefits 60-70% of patients
* higher dose for PUD over GERD

Antacids
* Neutralize gastric acids by acting as buffer

Antibiotics
* Usually four week treatment
* effective against H. Pylori

Question 11

diet treatment for PUD

Answer 11

Purpose of Nutrition Care is to avoid extreme elevation of gastric acid secretion and direct irritation of gastric mucosa
* Eat a well balanced diet
* Avoid frequent meals/bedtime eating that promote acid secretion (food may be irritant)
* Limit foods that may ↑ gastric acid secretion such as caffeine, black pepper, garlic, cloves, chilies/powder (this is subjective however)

hard to determine pain scale with biases in individual tolerances

Question 12

Lifestyle treatment for PUD

Answer 12

Contribute to making existing PUD worse
* Stop smoking
* Eliminate alcohol
* Avoid aspirin, and other NSAID’S
* ↓ stress (may be counterintuitive since a lot of people smoke to reduce stress)

Question 13

surgery for PUD

Answer 13

invasive and not the safest
* may be necessary for bleeding ulcer
* through muscle layer of GI lumen