Gastritis & Peptic Ulcer Disease

Question 1

inflammation, infection, or damage to the stomach’s mucosal lining

Answer 1

gastritis

Question 2

gastric irritation and atrophy caused by cellular changes or weakened host mechanisms

Answer 2

nonerosive gastritis

Question 3

what are the 2 most common causes of nonerosive gastritis?

Answer 3

pernicious anemia
H. pylori

Question 4

auto-immune disease resulting in B12 malabsorption due to decreased intrinsic factor

Answer 4

pernicious anemia

Question 5

what is the treatment for nonerosive gastritis caused by pernicious anemia? (2)

Answer 5

parenteral B12
PPI

Question 6

how does H. pylori cause nonerosive gastritis?

Answer 6

H. pylori secretes ammonia which breaks down the mucosal layer

Question 7

nonerosive gastritis caused by H. pylori in the body of the stomach would result in what?

Answer 7

gastric atrophy and irritation

Question 8

nonerosive gastritis caused by H. pylori in the atrum of the stomach would result in what?

Answer 8

erosions and ulcers

Question 9

a patient presents with anorexia, mid-epigastric pain and tenderness, and nausea. Dx?

Answer 9

nonerosive gastritis caused by H. pylori

Question 10

what are 3 non-invasive diagnostics that can be used for nonerosive gastritis caused by H. pylori?

Answer 10

fecal antigen immunoassay
urea breath test
serological ELISA

Question 11

what do fecal and breath tests both require?

Answer 11

D/C of PPI for 7-14 days and antibiotics for 28 days

Question 12

what is an invasive diagnostic that can be used for nonerosive gastritis caused by H. pylori?

Answer 12

upper endoscopy with biopsy

Question 13

what is the treatment for nonerosive and erosive gastritis caused by H. pylori?

Answer 13

standard triple therapy

PPI + clarithromycin + amoxicillin (metronidazole if PCN allergy)

Question 14

when should we test for eradication after completing the standard triple therapy?

Answer 14

> 4 weeks after completing treatment

Question 15

when should we expect for symptoms to improve after starting treatment for erosive and nonerosive gastritis caused by H. pylori?

Answer 15

7-14 days from starting therapy

Question 16

gastric mucosal erosion either due to inhibition of normal mucosal defenses allowing gastric fluids to damage tissues OR due to local damage from ingested items

Answer 16

erosive and hemorrhagic gastritis

Question 17

what are the 2 most common causes of erosive and hemorrhagic gastritis?

Answer 17

NSAIDs
H. pylori antral infection

Question 18

a patient presents with loss of appetite (anorexia), mid-epigastric pain and tenderness, nausea, nasogastric suction with coffee-ground or bright red blood, and possible melena on digital rectal exam. Dx?

Answer 18

erosive and hemorrhagic gastritis

Question 19

what is the diagnostic of choice for erosive and hemorrhagic gastritis?

Answer 19

upper endoscopy (EGD)

Question 20

what is the treatment for stress-induced erosive and hemorrhagic gastritis? (3)

Answer 20

continuous PPI infusion
PO sucralfate
+/- endoscopic repair

Question 21

what should all severely ill/injured patients with erosive/hemorrhagic gastritis be treated with?

Answer 21

prophylactic PPI PO/IV

Question 22

what is the treatment for NSAID-induced erosive and hemorrhagic gastritis? (4)

Answer 22

D/C NSAID / reduce to minimal dose / switch to selective COX-2 inhibitor

take NSAID with food
PPI for 2-4 weeks
+/- endoscopy if symptoms don’t improve

Question 23

what are the treatment options for alcohol or irritant foods-induced erosive and hemorrhagic gastritis? (3)

Answer 23

D/C offending agent
PPI
H2 blocker
sucralfate

all for 2-4 weeks

Question 24

what is the treatment for portal hypertension-induced erosive and hemorrhagic gastritis? (3)

Answer 24

propranolol
treat liver disease
PPI / sucralfate

Question 25

destruction of the gastric or duodenal mucosa by digestive factors, like acid and pepsin, due to impaired or overwhelmed mucosal defense mechanisms

Answer 25

peptic ulcer disease

Question 26

where do ulcers usually extend to and how big are they?

Answer 26

through muscularis mucosae > 5mm in diameter

Question 27

in which structure is PUD most commonly found?

Answer 27

duodenum

Question 28

what are the 2 most common causes of PUD?

Answer 28

H. pylori (#1) NSAID usage (#2)

Question 29

a patient presents with anorexia, nausea, mid-epigastric pain and tenderness, hunger-like/gnawing pain, and pain that worsens 2-5 hours after a meal that is improved with food buffers. Dx? Tx?

Answer 29

peptic ulcer disease *standard triple therapy* PPI (omeprazole) + clarithromycin + amoxicillin (metronidazole)

Question 30

a patient suspicious for PUD; physical exam shows rigid abdomen, guarding, and peritoneal sigs. what is the Dx?

Answer 30

PUD + perforated ulcer

Question 31

in a patient with PUD, free air on upright x-ray indicates _____

Answer 31

perforation

Question 32

what is the definitive diagnostic for PUD?

Answer 32

upper endoscopy

Question 33

what do red flags with ulcer or gastritis symptoms require?

Answer 33

EGD

Question 34

what are the ulcer and gastritis red flags? (9)

Answer 34

onset of sx > 50 yo progressive dysphagia odynophagia recurrent vomiting Sx despite appropriate treatment + FOBT, melena, hematemesis, anemia severe abdominal pain weight loss FHx of GI cancer in 1st degree relative