𝑷𝒆𝒑𝒕𝒊𝒄 𝑼𝒍𝒄𝒆𝒓 𝑫𝒊𝒔𝒆𝒂𝒔𝒆

Question 1

What are the four main aggravating factors for peptic ulcer disease?

Answer 1

NSAIDs, H. pylori infection, alcohol, and stress

Question 2

Which organism produces urease in peptic ulcer disease, and what does it do?

Answer 2

H. pylori produces urease, which breaks down urea into CO2 and ammonia, creating an alkaline environment

Question 3

How does the pain pattern differ between duodenal and gastric ulcers?

Answer 3

Duodenal ulcer pain is relieved by eating, while gastric ulcer pain worsens with eating

“Duodenal Digests, Gastric Gnaws.”

Question 4

What is the characteristic timing of gastric ulcer pain?

Answer 4

Burning sensation that occurs after meals

Question 5

What are the three main diagnostic tests for peptic ulcer disease?

Answer 5

Endoscopy (definitive diagnosis), H. pylori test, and urea breath test

Question 6

What is the standard triple therapy for H. pylori-associated ulcers?

Answer 6

Proton pump inhibitor (PPI) + Clarithromycin + Amoxicillin

Question 7

What is an alternative triple therapy regimen for H. pylori eradication?

Answer 7

PPI + Amoxicillin + Metronidazole

Question 8

What are the four major complications of peptic ulcer disease?

Answer 8

Bleeding, perforation, obstruction (due to fibrosis), and malignancy

Question 9

What does epigastric pain radiating to the back suggest in ulcer disease?

Answer 9

Possible penetration into the pancreas

Question 10

What protective factors help prevent ulcer formation?

Answer 10

Bicarbonate
Mucus
Mucosal blood flow
Epithelial renewal
Tight intercellular junction

Question 11

How does severe stress contribute to ulcer formation?

Answer 11

It disrupts the balance between mucosal defense mechanisms and aggravating factors

Question 12

What is Zollinger-Ellison syndrome, and how does it relate to ulcers?

Answer 12

A condition characterized by excessive gastric acid production, leading to ulcers

Question 13

What are the two main scoring systems for assessing bleeding risk in ulcer disease?

Answer 13

Rockall score (0-11) and Blatchford score (0-23)

Question 14

What is the endoscopic appearance of Type 3 ulcers?

Answer 14

Lesions without bleeding
(appearing as a flat spot with a clean ulcer base)

Question 15

What are the signs of active bleeding in peptic ulcer disease?

Answer 15

Spurting or oozing from visible vessels

Question 16

What is the role of cimetidine in ulcer treatment?

Answer 16

An H2 receptor blocker that reduces acid secretion

Question 17

How does metaplasia contribute to ulcer disease?

Answer 17

Duodenal mucosa transforms into gastric mucosa, reducing bicarbonate secretion

Question 18

What distinguishes Type 1 from Type 2 ulcers?

Answer 18

Type 1: Located at the angularis incisura; Type 2: Includes both incisura and duodenal ulcers

Question 19

What is the significance of the AIMS65 score?

Answer 19

A risk assessment tool for upper gastrointestinal bleeding

Question 20

What symptoms suggest ulcer complications?

Answer 20

Water brash, chest discomfort, and hematemesis

Question 21

Why is endoscopy the gold standard for diagnosing peptic ulcers?

Answer 21

It provides direct visualization and allows for biopsy if needed

Question 22

How does H. pylori stimulate acid production?

Answer 22

It induces parietal cell hyperplasia through an inflammatory response

Question 23

What lifestyle modifications help manage peptic ulcers?

Answer 23

Avoid smoking, alcohol, and NSAIDs

Question 24

What characterizes NSAID-induced ulcers (Type 5)?

Answer 24

Ulcers caused by prolonged NSAID use, requiring discontinuation of NSAIDs

Question 25

What is the significance of prepyloric ulcers (Type 3)?

Answer 25

They occur near the pylorus and can affect gastric emptying

Question 26

Why is the combination of NSAIDs and H. pylori particularly dangerous?

Answer 26

They synergistically weaken mucosal defenses, increasing ulcer risk

Question 27

What role does gastrin play in ulcer formation?

Answer 27

It stimulates enterochromaffin-like (ECL) cells to release histamine, increasing acid production

Question 28

How does smoking contribute to ulcer formation?

Answer 28

It increases acid secretion and reduces mucosal blood flow

Question 29

What is the endoscopic appearance of an adherent clot on an ulcer?

Answer 29

It appears as a Type 2b lesion, indicating recent bleeding

Question 30

Why are Type 4 ulcers (gastroesophageal junction) clinically significant?

Answer 30

They can affect both esophageal and gastric function

Question 31

What causes the alkaline tide in ulcer disease?

Answer 31

H. pylori's urease activity, which generates ammonia and increases pH

Question 32

How do parietal cells contribute to ulcer formation?

Answer 32

They produce hydrochloric acid (HCl), which can damage the mucosa if protective mechanisms fail

Question 33

When should surgical intervention be considered for ulcers?

Answer 33

For complications like uncontrolled bleeding, perforation, or obstruction

Question 34

What is the role of the Meissner plexus in ulcer disease?

Answer 34

It regulates mucosal secretion and blood flow, affecting mucosal defense

Question 35

Why is pain worse at night in duodenal ulcers?

Answer 35

Increased acid secretion and reduced food buffering during fasting

Question 36

How does chronic ulcer disease affect gastric motility?

Answer 36

It can lead to fibrosis and gastric outlet obstruction

Question 37

What role do chief cells play in ulcer formation?

Answer 37

They produce pepsinogen, which is converted to pepsin, contributing to mucosal damage

Question 38

Why is timely treatment of H. pylori important?

Answer 38

To prevent chronic inflammation and potential malignant transformation

Question 39

What makes the antrum particularly susceptible to ulcers?

Answer 39

Its location and exposure to acid and pepsin

Question 40

What is a peptic ulcer?

Answer 40

A defect in the mucosa of the esophagus, stomach, duodenum, or Meckel’s diverticulum that occurs in the presence of acid and pepsin.

Question 41

What is the underlying cause of peptic ulcers?

Answer 41

An imbalance between mucosal defense mechanisms and aggressive factors like acid and pepsin.

Question 42

How has the management of peptic ulcer disease evolved over time?

Answer 42

The development of PPIs, H2 blockers, effective antibiotics against H. pylori, and endoscopic treatment has reduced the need for surgery.

Question 43

Why has the role of open surgery in peptic ulcer disease declined?

Answer 43

Due to the availability of effective medical and endoscopic treatments.

Question 44

What part of the stomach secretes acid?

Answer 44

The parietal cells in the gastric mucosa.

Question 45

What role do nerves play in gastric acid secretion?

Answer 45

The vagus nerve stimulates acid secretion through acetylcholine release.

Question 46

What infection is strongly linked to peptic ulcer disease?

Answer 46

Helicobacter pylori infection.

Question 47

How do NSAIDs contribute to peptic ulcer formation?

Answer 47

By inhibiting prostaglandin synthesis, which reduces mucosal protection.

Question 48

What lifestyle factors increase the risk of peptic ulcers?

Answer 48

Smoking, excessive alcohol consumption, and stress.

Question 49

What genetic conditions are associated with peptic ulcer disease?

Answer 49

Zollinger-Ellison syndrome and G-cell hyperplasia.

Question 50

How does physiological stress contribute to peptic ulcer formation?

Answer 50

By increasing acid secretion and impairing mucosal defense mechanisms.

Question 51

What are the two main types of peptic ulcers?

Answer 51

Gastric ulcers and duodenal ulcers.

Question 52

Where do most duodenal ulcers occur?

Answer 52

In the first part of the duodenum.

Question 53

What is a stress ulcer?

Answer 53

An ulcer that occurs due to severe physiological stress, such as in critically ill patients.

Question 54

What is the most common cause of peptic ulcer disease?

Answer 54

H. pylori infection.

Question 55

What is Zollinger-Ellison syndrome?

Answer 55

A condition characterized by excessive gastric acid production due to gastrin-secreting tumors.

Question 56

How does G-cell hyperplasia contribute to peptic ulcer disease?

Answer 56

By increasing gastrin levels, leading to excessive acid secretion.

Question 57

How does H. pylori survive in the acidic environment of the stomach?

Answer 57

It produces urease, which converts urea into ammonia, creating a protective alkaline environment.

Question 58

What effect does H. pylori infection have on acid secretion?

Answer 58

It stimulates acid production by inducing parietal cell hyperplasia.

Question 59

What happens when excess acid reaches the duodenum?

Answer 59

It leads to gastric metaplasia and reduced bicarbonate secretion, making the duodenum more susceptible to ulceration.

Question 60

What are the long-term complications of surgery for peptic ulcer disease?

Answer 60

Duodenogastric reflux, diarrhea, weight loss, osteomalacia, iron deficiency anemia, gallstones, gastric stump carcinoma, and colonic carcinoma.

Question 61

Why does gastric stump carcinoma occur after surgery?

Answer 61

Chronic irritation from duodenogastric reflux increases cancer risk, typically developing 20 years post-surgery.

Question 62

Why is the incidence of gallstones increased after truncal vagotomy?

Answer 62

Due to decreased gallbladder motility.

Question 63

What is afferent loop syndrome?

Answer 63

A complication where the afferent limb of a gastrojejunostomy becomes obstructed, leading to pain and vomiting.

Question 64

What is a gastrojejunocolic fistula?

Answer 64

An abnormal connection between the stomach, jejunum, and colon, often resulting from chronic ulceration.

Question 65

Why are patients at increased risk of infections post-surgery?

Answer 65

Due to altered gastric physiology and impaired immune response, leading to conditions like pulmonary tuberculosis and gastric mycosis.

Question 66

What are the common symptoms of peptic ulcer disease?

Answer 66

Epigastric pain, nausea, vomiting, bloating, and melena.

Question 67

How does the pain of gastric ulcers differ from duodenal ulcers?

Answer 67

Gastric ulcer pain worsens with food intake, while duodenal ulcer pain improves with food.

Question 68

What is the gold standard for diagnosing peptic ulcer disease?

Answer 68

Upper gastrointestinal endoscopy.

Question 69

What tests can be used to detect H. pylori infection?

Answer 69

Urea breath test, stool antigen test, and biopsy with urease testing.

Question 70

What are the main medical treatments for peptic ulcer disease?

Answer 70

Proton pump inhibitors (PPIs), H2 blockers, and H. pylori eradication therapy (antibiotics).

Question 71

When is surgical treatment indicated for peptic ulcer disease?

Answer 71

In cases of life-threatening complications, perforation, obstruction, or refractory ulcers.

Question 72

How does the prognosis of peptic ulcer disease change with effective treatment?

Answer 72

Most cases resolve with medical therapy, but complications like perforation or bleeding may require surgical intervention.