S09C81 - PUD and gastritis

Question 1

Gastritis=

Answer 1

Acute or chronic inflm of gastric mucosa

Question 2

Dyspepsia=

Answer 2

-continuous or recurrent upper abdominal pain or discomfort with or without associated symptoms

Question 3

PUD etiology

Answer 3

• h pylori is present in 95% of duo ulcers and 70% of gastric ulcers however only 15% of infected people develop PUD
• hp also assoc with mucosa-assoc lymphoma and adenocarcinoma of the stomach and iron deficiency anemia and possibly ITP

-NSAIDs decr prostaglandin production and therefore decr protection against acidity

Question 4

PUD - symptoms

Answer 4

• pain often relieved by eating, milk, and then recurs once gastric contents empty
• not assoc with PUD: postprandial pain, food intolerance, nausea, retrosternal pain, belching

Question 5

PUD - Dx

Answer 5

-gold standard: visualization of ulcer by endoscopy (SS 95%)

Question 6

PUD: alarm symptoms

Answer 6

The following pts require endoscopy:

• > 55yo
• unexplained wt loss
• early satiety
• persistent vomiting
• dysphagia
• anemia/GI bleeding
• abdo mass
• persistent anorexia
• jaundice

Question 7

H. pylori dx

Answer 7

• rapid urease test from biopsy specimen (>90% sens, 95% sp)
• histology study with stains (95% ss) $$
• PCR - used mostly in research
• IgG antibody serum test (80%ss, 90%sp)
• urea breath test (detects urea produced by hp) >95% ss/sp (CI in children and pregnancy)
• hp stool Ag test >90% ss/sp

-PPI will obscure results

Question 8

H pylori Tx

Answer 8

Triple tx: PPI, clarithromycin, amox/flagyl

x 14d

Question 9

PUD tx if no HP

Answer 9

• PPI
• H2 receptor antagonist (ranitidine)
• sucralfate
• antacids