L14: Peptic Ulcer

Question 1

Def of Peptic Ulcer

Answer 1

Defect in the gastrointestinal mucosa that extend through the muscularis mucosa ( > 5 mm)

Question 2

Sites of Peptic Ulcer

Answer 2

Question 3

Pathophysiology of Peptic Ulcer

Answer 3

Peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms
is disrupted

Question 4

Etiology of Peptic Ulcer

Answer 4

Question 5

Characters of H.Pylori

Question 6

Peptic ulcer may be associated with (4Cs)

Answer 6

Cigarette smoking, Cirrhosis of liver,
COPD, and Chronic renal failure

Question 7

CP of Peptic ulcer

Answer 7

• Asymptomatic
• Symptomatic
• Complications

Question 8

Asymptomatic Peptic ulcer

Answer 8

Approximately 70% of peptic ulcers are asymptomatic.

Question 9

Symptoms of Peptic ulcer

Answer 9

• Epigastric pain/ Dyspepsia
• anorexia
• nausea
• vomiting.

Question 10

Characters of Epigastric pain of PU

Answer 10

burning, gnawing or dull ache

Question 11

Sites of Epigastric pain of PU

Answer 11

• DU : above the umbilicus & to the right of the midline.
• GU : epigastric & in the midline

Question 12

Duration of Epigastric pain of PU

Answer 12

variable from few minutes to several hours.

Question 13

Relation of Epigastric pain of PU to food

Answer 13

• DU : 2 - 3 h after meals (usually awakens the patient)
• GU : precipitated by food ½ h after meals

Question 14

Relieving factors of Epigastric pain of PU

Answer 14

• DU : antacid or food , so appetite ↑ ( patient eats frequently to relief pain)
• GU : fasting , vomiting ( some patients learn to induce vomiting for pain relief )

Question 15

Complications of Peptic Ulcer

Answer 15

Question 16

Investigations in Peptic Ulcer

Answer 16

I. Upper GI endoscopy (Diagnostic)
II. Investigations for the cause
III. Investigations for complications

Question 17

Upper GI Endoscopy in Peptic Ulcer

Answer 17

The gold standard in diagnosing PUD

Question 18

When to Bx a Peptic Ulcer?

Answer 18

• DU are mostly benign, do not require biopsy except in the setting of Crohn’s disease.
• DU patients should have antral biopsy to diagnose H pylori.
• GU patients over 40 years should have biopsy to exclude gastric cancer.

Question 19

Investigations for the cause in PU

Answer 19

Question 20

Investigations for complications in PU

Answer 20

Question 21

Lab Findings in PU

Answer 21

Question 22

Imaging in PU

Answer 22

Question 23

DDx of PU

Answer 23

Question 24

Managment of PU

Answer 24

I. Treat the underlying etiology
II. Antisecretory therapy
III. Other general measures
IV. Management of complication

Question 25

TTT of underlying cause in PU

Answer 25

1) Eradication of H. pylori 2) Discontinue NSAIDs - In patients with PUD of unclear etiology, additional evaluation is needed to exclude other rare causes

Question 26

Eradication of H.Pylori

Answer 26

Question 27

Types of Antisecretory therapy

Answer 27

- PPIs - H2RAs - Antacids - Sucralfate

Question 28

Significance of PPIs in PU

Answer 28

First-line antisecretory therapy in the treatment of PUD.

Question 29

MOA of Proton pump inhibitors (PPIs)

Answer 29

Irreversible inhibitor of H+ K+ ATPase

Question 30

Nature of Proton pump inhibitors (PPIs)

Answer 30

Prodrugs requiring activation in acid environment

Question 31

Timimg of Proton pump inhibitors (PPIs)

Answer 31

Administered 30 to 60 minutes before breakfast for maximal inhibition of proton pumps

Question 32

Examples of Proton pump inhibitors (PPIs)

Answer 32

 Omeprazole  Pantoprazole  Lansoprazole  Rabeprazole  Esomeprazole

Question 33

Duration of Proton pump inhibitors (PPIs)

Answer 33

 DU : 4 weeks  GU : 8 weeks

Question 34

MOA of Histamine-2 receptor antagonists (H2RAs)

Answer 34

Reversible competitive inhibitors of H2 receptor on the parietal cell.

Question 35

Selectivity of Histamine-2 receptor antagonists (H2RAs)

Answer 35

Highly selective, No action on H1 or H3 receptors.

Question 36

Histamine-2 receptor antagonists (H2RAs) & Nocturnal acid secretion

Answer 36

Effective in inhibiting nocturnal acid secretion

Question 37

Examples of Histamine-2 receptor antagonists (H2RAs)

Answer 37

Cimetidine, Famotidine, Nizatidine

Question 38

SE of Cimtidine

Answer 38

- May cause gynecomastia, galactorrhea - Inhibits CYP450 & may increase conc. Of Warfarin, Theophylline, Phenytoin

Question 39

Ranitidine Withdrawn by FDA due to Contamination with ......

Answer 39

nitrosodimethylamine (NDMA)

Question 40

Composition of **Antacids**

Answer 40

Usually contain a combination of magnesium trisilicate, aluminum hydroxide, or calcium carbonate

Question 41

MOA of **Antacids**

Answer 41

Antacids can neutralize gastric acid and reduce acid delivery to the duodenum

Question 42

Comnposition of **Sucralfate**

Answer 42

Salt of sucrose complexed to sulfated aluminium hydroxide

Question 43

MOA of **Sucralfate**

Answer 43

In acidic pH polymerises to viscous gel that adheres to ulcer crater

Question 44

Timing of **Sucralfate**

Answer 44

Taken on empty stomach 1 hr. before meals

Question 45

Although Antacids and Sucralfate can heal duodenal ulcers, they are ......

Answer 45

not routinely recommended to treat peptic ulcers as PPIs heal ulcers more rapidly and to a greater extent.

Question 46

What are other general Measures in PU?

Answer 46

 Avoid tobacco  Avoid alcohol  Avoid hot, spicy, and greasy foods  Weight loss  Do not eat before bed

Question 47

Managment of Complications in PU

Question 48

Managment of Bleeding PU

Answer 48

Question 49

Managment of Gastric outlet obstruction in PU

Answer 49

Question 50

Managment of Perforated PU

Answer 50

Question 51

Done

Answer 51

..