GI-Peptic Ulcer Disease

Question 1

Peptic Ulcer Disease

Answer 1

Path: 2 locations: Gastric, Duodenal
5 etiologies
- H. Pylori: Single
- NSAIDS: multiple shallow
- Malignancy: heaped, necrotic 
- Curling's: Burns
- Cushing's: Steroids
- Gastrinoma

Pt: ASX (20%)
Gnawing epigastric pain
Pain increased w food (gastric)
Pain decreased w food (duodenal)

Dx: EGD w biopsy

• r/o malignancy
• r/o H. Pylori

Tx: PPI!!!!!!
Stop alcohol
Stop NSAIDs
Stop smoking

Question 2

H. Pylori

Answer 2

Path: Infxn

Pt: Asx (85%)
PUD + Dyspepsia (15%)
MALToma (approx. 1%)

Dx: Serology = Test and Treat (once)
Urea Breath Test = Initial Test
Stool Antigen = Eradication
EGD w Bx = Best (histology)

Tx: Triple Therapy

• Clarithromycin
• Amoxicillin (MTZ backup)
• PPI

F/u: MALToma…..treat H. Pylori, treat the cancer

Question 3

Zollinger-Ellison (Gastrinoma)

Answer 3

Path: Gastrinoma…. decreased Gastric pH

Pt: Big, virulent, refractory ulcers….and diarrhea

Dx: Gastrin
< 250 = Normal
Btwn = Secretin Statin
>1600 = Gastrinoma

SRS!!!!! (clarify)
CT Scan

Tx: Resection