Flashcards in peptic ulcer disease Deck (44)
How does peptic ulcer pain present?
hunger sensation, gnawing dull burning pain. Nausea
Where is the pain in peptic ulcers?
What are the three things about the timing of peptic ulcer pain that are important?
1. Onset 1-3 hrs after meals
2. Awakens from sleep
3. Relieved by food/antacid
What percentage of people have silent ulcers?
What percentage of people with ulcer like symptoms only have DYSPEPSIA w/o the ulcer?
what are the three complications of peptic ulcers?
What are the two ways in which peptic ulcer hemorrhages might present?
1. POSTERIOR duodenal ulcers erode into major arteries
2. Gastric ulcers can lead to severe/persistent bleeding
What kinds of ulcers likely cause perforation?
anterior DU or GU
What would you see on X ray or CT scan in perforation?
Free air in the peritoneal cavity
What is obstruction?
Scarring and stenosis of the gastric outlet.
What is a prominent feature of peptic ulcer obstruction?
Vomiting, often of old food
Why are the weaknesses of using barium radiograph to diagnose an ulcer?
It can't tel the difference between a benign ulcer and a gastric cancer that has ulcerated
What is the benefit ofendoscopy?
Can take biopsies to exclude cancer and detect H pylori
What are the methods available for detecting H pylori?
2. rapid urease test on biopsy
3. urea breath test
4. Serum antibodies to H pylori (present after eradication of organism)
5. Stool antigen test
Where are gastric ulcers usually found?
On the lesser curvature of the stomach
Where are duodenal ulcers found?
In the duodenal bulb
jejunal ulcers are unusual. When might you see them?
In Zollinger Ellison syndrome
ileal ulcers are also unusual. When might you see them?
Merckel's diverticulum with abnormal gastric mucosa
What are the three ways in which H pylori causes chronic superficial gastritis?
1. Stimulating release of IL-1, IL-6, IL-8, and TNF-a
2. Gastric metaplasia, causing inflammation/ulceration
3. Suppression of somatostatin, causing hypergastrinemia
How does PGE2 maintain mucosal integrity?
1. Stimulates mucus production
2. Increase mucosal blood flow (ischemia causes back diffusion of H+ ions, hemorrhage, and ulceration
Stimulation of bicarb, and epithelial migration/proliferation
How do NSAIDS decrease PGE2?
Inhibition of cyclo-oxygenase-1-->PGE2
What protects the duodenum from acid?
Brunner's glands produce mucus with high buffer capacity
Also, biliary and pancreatic secretion have high bicarb
What are other risk factors for peptic ulcer disease?
Cigarette smoking (most important)
How does misoprostol work?
It prevents NSAID ulcers. It's a PGE2 that enhances mucosal production and reduces acid secretion
Sucralfate protects damaged mucosa
What are other ulcerogenic drugs?
What are the side effects of tums?
Hypercalcemia can stimulate acid production, and release of gastrin
What are the side effects of aluminum hydroxide?
constipation, anorexia, weakness, and bond pain
What are the H2 receptor antagonists?
cimetidine, ranitidine, famotidine nizatidine