Peptic Ulcer Disease Flashcards
Kinds of ulcers
Gastric and duodenal
What does ulcer severity tell you?
The deeper the ulcer, the more severe the damage is
How can you determine the ulcer severity?
Main symptom of PUD
PUD’s association with food
Duodenal ulcers- food helps the pain
Gastric ulcer- food makes it worse
Patients with duodenal ulcers will describe what symptom?
Pain that wakes them up at midnight-3 AM
The #1 cause of PUD is due to what?
H. pylori bacteria
H. pylori tends to cause what kind of ulcers?
Features of H. pylori
Spiral shape with flagellum
Protective mechanisms against stomach acid
Protective mechanisms of H. pylori
Convert urea to ammonia and bicarb
Produces lipases and proteases to degrade mucus later
Induces inflammatory immune response
Diagnosis methods of PUD
Endoscopy and blood tests
Tests used to determine eradication of H. pylori infection
Breath tests and fecal antigen tests
What class of drugs is the #1 cause of drug-related toxicity in the US?
How can NSAIDs cause ulcers?
Decreases prostaglandin effects
Epithelial cell turnover
Weak acids crossing into epithelial cells and getting trapped
Risk factors for NSAID-induced PUD
>65 years Past history of an ulcer or PUD Concomitant steroid use with NSAID (mostly non-selective NSAIDs) Anticoagulants (warfarin, DOACs) Antiplatelets (ASA, Plavix, P2Y12is)
How many risk factors do you need to start on PPI prophy for NSAID-induced PUD?
Diagnosis of NSAID-induced PUD
Patients describing dyspepsia symptoms
NSAID taking history
Alcohol use and PUD
Usually causes superficial gastritis and nothing life-threatening
What patients are at risk for stress-related mucosal bleeding due to illness PUD?
Patients who are in the hospital ICU with sepsis, mechanical ventilation, etc.
Altered defense mechanisms in patients with critical illness PUD
No acid in stomach
Decreased blood flow to GI tract due to hypotension
Release of damaging mecanisms