36. Peptic ulcer disease Flashcards Preview

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Flashcards in 36. Peptic ulcer disease Deck (34):
1

types according to location

1. gastric ulcer
2. duodenal ulcer

2

gastric vs duodenal ulcers according to pain and meals

gastric ulcer ---> greater with meals (weight loss )
duodenal ulcer --> decrease with meals (weight gain )

3

gastric vs duodenal ulcers according to frequency on H.pylori infenction

1. gastric ulcer---> 70%
2. duodenal ulcer ---> 90%

4

gastric vs duodenal ulcers according to mechanism

1. gastric ulcer---> decreased mucosal protection against gastric acid
2. duodenal ulcer ---> decreased mucosal protection or increased gastric acid secretion

5

gastric vs duodenal ulcers according to other causes

1. gastric ulcer---> NSAID, bile reflux
2. duodenal ulcer ---> Zollinger-Ellison

6

gastric vs duodenal ulcers according to risk of cancer

-gastric ulcer ---> increased
-duodenal ulcer --> generally benign (almost never malignant )

7

gastric vs duodenal ulcers - gastric ulcer - management

biopsy margins to rule out malignancy

8

duodenal ulcers - special histological characteristic

hypertrophy of Brunner glands

9

Gastric ulcer associated with carcinoma - apperance

large (more than 3cm ), sharply ddemarcated (punched out ) and surrounded by radiating folds of mucosa

10

Gastric ulcer - complications

1. hemorrhage
2. obstruction
3. perforation
4. cancer

11

MC complication of gastric ulcer

hemorrhage

12

perforation - location

most commonly anterio ( > posteruir) duodenal

13

perforation - manifestations

may see free air under diaphragm with referred pain to the shoulder via phrenic nerve

14

Gastric ulcer - mc location

lesser curvature

15

obstruction - location

pyloric channel
duodenal

16

hemorrhage - location

gastric ( lesser )
duodenal posterior ( > anterior)

17

gastric ulcer - hemorrhage

ruptured ulcer on the lesser curvature --> bleeding from left gastric artery

18

duodenal ulcer - hemorrhage

ruptured ulcer on the posterior wall -- > bleeding from gastroduodenal artery

19

duodenal ulcer - hemorrage vs perforation according to location

perforation is more commonly anterior hemorrhage is more commonly posterior ( gastroduodenal artery )

20

risk factors for gastrointestinal reflux

1. alcohol
2. tobacco
3. obesity
4. fat-rich diet
5. caffeine
6. hiatal hernia

21

esophageal cancer - obesity is risk factor for.... (type)

adenocarcinoma

22

• Does the pain associated with duodenal ulcers increase, decrease, or remain the same with food?

Decrease (Duodenal ulcer pain is Decreased with food)

23

• This type of gastrointestinal ulcer is more likely to be associated with weight gain.

Duodenal ulcer (the pain associated with duodenal ulcers decreases with meals, thereby resulting in weight gain)

24

• Patients with duodenal ulcers tend to have hypertrophy of these glands.

Brunner glands

25

• A man with stomach pain is found on endoscopy to have a lesion with irregular, raised margins. Is this more likely an ulcer or a malignancy?

Malignancy (carcinoma)—peptic ulcers have clean margins and a punched-out appearance

26

• In a patient with Zollinger-Ellison syndrome, what type of ulcer is the patient at risk for?

Duodenal ulcer (Zollinger-Ellison syndrome is associated with increased gastric secretions, resulting in ulcer formation)

27

• An elderly patient who takes high-dose NSAIDs is likely to at increased risk for what type of ulcer?

Gastric ulcer

28

• What is the pathology of duodenal ulcers?

Decrease in mucosal protection or increase in gastric acid secretion

29

• Which type of peptic ulcer disease puts the patient at a higher risk of developing a carcinoma?

Gastric ulcer

30

• Peptic ulcer disease affects what two regions of the gastrointestinal tract?

The stomach (gastric ulcers) and the duodenum (duodenal ulcers)

31

• A patient has significant weight loss and abdominal pain after eating. Endoscopy shows ulcers. What kind of ulcers are they likely to be?

Gastric ulcers, which generally result in increased pain after meals (Gastric ulcer pain is Greater with meals)

32

• What etiologic factor is associated with 70% of gastric ulcers?

Helicobacter pylori infection

33

• A patient on NSAIDs for back pain presents with abdominal pain exacerbated by meals. What is the most likely cause of his abdominal pain?

Chronic use of NSAIDs leading to gastric ulcers

34

• What is the pathophysiology of gastric ulcers?

Decreased mucosal production leading to destruction of tissue by gastric acid due to decreased protection

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