dyspepsia and PUD Flashcards Preview

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Flashcards in dyspepsia and PUD Deck (22):
1

upper abdominal pain: better with food, worse after eating
"heartburn", nausea
full after eating (satiety)
black or bloody stool (+occult blood, may be sporadic)
anemia: pale conjunctiva, tachycardia, hypotension, orthostasis
tender epigastric region
hx DAILY NSAID use

bleeding peptic ulcer

2

work-up for dyspepsia if

stat CBC (may need transfusion)
stop NSAID
if vomit/not eating: chemistry panel
if biliary or pancreatic disease suspected: liver enzymes, amylase, lipase
if possible perforation: CXR
if gallstones suspected: U/S
if possibly pregnant + ectopic pregnancy or pelvic infection: pregnancy test +/- cervical cultures
test for H. pylori: IgG serology, if + confirm with 13-C urea breath test or stool antigen test
if H.pylori +: antibiotics with PPI
if H. pylori -: treat empirically with PPI for 4-8 wks
if continue to be symptomatic, upper GI endoscopy

3

reduce risk of recurrence of peptic ulcer

avoid NSAIDs
use PPI or misoprostol with NSAID
test for active h. pylori if on long-term nsaid tx
eradicate H. pylori

4

criteria for dypepsia: rome III

1 or more of following:
postprandial fullness
early satiety
epigastric pain or burning

5

causes of dyspepsia

PUD (20% cases): epigastric ab pain improves with food ingestion, pain few hours after eating, pain between 11 pm - 2am (max acid secretion), gradual onset, wks-mo sx
GERD: predominately heartburn/acid regurg
functional dyspepsia

6

mucosal damage secondary to pepsin + gastric H+ secretion

PUD
stomach (if use NSAIDS), proximal duodenum (most common)
less common: lower esophagus, distal duodenum, jejunum (zollinger-ellison syndrome: gastrinoma, hiatal hernias, ectopic gastric mucosa in meckel diverticulum)

7

early upper GI endoscopy if new onset dyspepsia + > 55 yo OR any of these alarm symptoms associated with upper GI malignancy

unintentional weight loss
progressive dysphagia
recurrent/persistent vomiting
odynophagia (painful swallowing)
unexplained anemia
GI bleeding/hematemesis
family hx of upper GI cancer
hx gastric surgery
jaundice

8

risk factors for PUD

H. pylori infection
NSAID use
smoking
personal or family hx of PUD
meds: steroids, bisphosphonates, chemo drugs
stress: acute illness, multiorgan failure, ventilator
malignancy: gastric, lymphoma, lung cancer
black or hispanic

9

ulcers following head injury

cushing ulcer

10

ulcers following burn

curling ulcer

11

inhibit H2 R on gastric parietal cells

H2 blocker

12

inhibit HK ATPase proton pump in gastric parietal cells

PPI

13

RUQ pain/tenderness

gallbladder or biliary disease

14

epigastric pain radiates to back
N/V

pancreatitis

15

NSAID-induced ulcers

complications more common in
elderly
co-occuring H. pylori
steroid or anticoagulant

16

G- bacillus
found in 50% with PUD (5-7x increase risk of PUD)
usually maternally acquired as a child
can develop into gastric cancer

H. pylori

17

complications of PUD

hemorrhage
gastric outlet obstruction
silent ulcer
more common in: elderly, NSAIDs

18

if >50 yo with blood in stool OR anemia regardless of upper GI findings (ulcer or no ulcer)

need colonoscopy to r/o colon cancer

19

preferred non-invasive test for h. pylori

stool antigen test:
good PPV
test post-tx for eradication
limitation: did not use PPI at least 2 weeks prior to testing

20

blood screening test for h. pylori

IgG serology
inexpensive, non-invasive
highly sensitive for hx of infection
limitation: can't distinguish active from a treated infection, can't determine if have ULCERS
if +: f/u with urea test to confirm ACTIVE infection THEN treat

21

urea breath test

inhale carbon labeled urea, metabolized by urease from h. pylori
highly sensitive + specific for ACTIVE infection
test post-tx for eradication
limitation: expensive

22

gold standard for diagnosis of h. pylori

endoscopy with biopsy testing