Peptic Ulcer Disease Flashcards
(30 cards)
What are the two biggest stimulants for Gastrin secretion?
- Luminal proteins in the stomach
2. Gastrin Releasing Peptide (GRP)
What are the 3 things that stimulate acid secretion from gastric parietal cells.
- Histamine
- Gastrin
- ACh
What is Zollinger-Ellison syndrome?
One of the Multiple Endocrine Neoplasms (MEN) Type 1 that involves a Gastrin secreting tumor in pancreatic islet cells
What are the 3 classifications of Gastritis and examples of each?
- Erosive Hemorrhagic: stress or ICU induced, NSAID induced, reflux injury
- Non-erosive Non-specific: H. pylori, autoimmune, cancer
- Specific: micro infections
What is the etiology, diagnosis, and treatment for Type A vs. Type B gastritis?
Type A:
- Autoimmune
- Achlorohydria
- Life-long IV Vit. B 12
Type B
- H. Pylori
- Urea breath test
- if required, PPI w/ antibiotics
What is the final clinical manifestation of Chronic Atrophic Gastritis?
Pernicious anemia, pts. need parenteral Vit. B12
What are the 3 main etiologies of Peptic Ulcers?
- H. Pylori
- NSAID abuse
- Stress
What are the 4 biggest risk factors for PUDs?
- Smoking
- Alcohol
- Adrenocorticosteroid use longer than 1 week
- NSAID use
Most sensitive test to detect PUD.
Endoscopy (95%)
-h&p along with upper GI radiology is also useful
What is the biggest contraindication for using PG analogs to treat PUD?
PGs cause smooth muscle contraction and could cause spontaneous abortion in pregnant patients.
What is the management strategy for peptic ulcers?
Duodenal ulcers: either PPI, sucralfate, or H2RAs for 4-8 weeks. Antibiotics if H. pylori is present.
Stomach ulcers: the same except for a repeat endoscopy is performed to check for malignancy.
What 3 things should be considered if a patient has a non-healing ulcer?
- ZE syndrome
- Smoker
- NSAID use
What is the treatment for a bleeding ulcer?
Contact thermal probe with endoscopy.
NO PHARM THERAPY CAN STOP AN ULCER BLEED!!!!
-some can only prevent it
What is the treatment for an ulcer caused by a gastric obstruction?
Continuous IV PPI with surgical pyloroplasty or endoscopic balloon.
Type of gastritis associated with H. pylori
Type B
Excluding NSAID abuse and ZE syndrome, what is 99.9% associated with duodenal ulcers?
H. pylori infection
-not all people with this infection develop duodenal ulcers
What is dyspepsia?
Indigestion, recurrent pain in the upper abdomen.
What are management recommendations for patients that have Non-Ulcer Dyspepsia?
Younger than 55: test and treat approach, PPI trial
Older than 55 or w/ alarming symptoms: endoscopic exam and treatment based on these findings
What are the three best tests to diagnose and monitor H. pylori infection?
- Gastric Biopsy (gold standard)
- Carbon-urea breath test (most commonly used to test if treatment worked)
- Stool or Urine antigen test (good for documenting eradication 4 weeks post treatment)
Which group of people infected with H. pylori is most crucial to treat?
Patients with a past history of gastric MALT lymphoma. (MOST IMPORTANT)
Patients with current stomach or duodenal ulcers or patients with past history of complications should also be treated.
What is the standard treatment for H. pylori infection?
PPI/amoxicillin/clarithromycin
10-14 day
What is Menetrier disease and how is it treated?
Hypertrophic gastric folds of unknown etiology.
Treat with PPI, H2RA, and prednisolone
What is eosinophilic gastritis and how is it treated?
Inflammation of gastric mucosa most likely caused by an allergic reaction.
Treatment is prednisolone steroids to suppress the immune system.
What are gastric bezoars?
A type of solid mass or concretion of foreign matter that becomes lodged in the stomach.
