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Flashcards in peptic ulcer disease Deck (44):
1

How does peptic ulcer pain present?

hunger sensation, gnawing dull burning pain. Nausea

2

Where is the pain in peptic ulcers?

epigastric

3

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

4

What percentage of people have silent ulcers?

40%

5

What percentage of people with ulcer like symptoms only have DYSPEPSIA w/o the ulcer?

60-90%

6

what are the three complications of peptic ulcers?

hemorrhage
perforation
obstruction

7

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

8

What kinds of ulcers likely cause perforation?

anterior DU or GU

9

What would you see on X ray or CT scan in perforation?

Free air in the peritoneal cavity

10

What is obstruction?

Scarring and stenosis of the gastric outlet.

11

What is a prominent feature of peptic ulcer obstruction?

Vomiting, often of old food

12

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

13

What is the benefit ofendoscopy?

Can take biopsies to exclude cancer and detect H pylori

14

What are the methods available for detecting H pylori?

1. Histology
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

15

Where are gastric ulcers usually found?

On the lesser curvature of the stomach

16

Where are duodenal ulcers found?

In the duodenal bulb

17

jejunal ulcers are unusual. When might you see them?

In Zollinger Ellison syndrome

18

ileal ulcers are also unusual. When might you see them?

Merckel's diverticulum with abnormal gastric mucosa

19

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

20

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

21

How do NSAIDS decrease PGE2?

Inhibition of cyclo-oxygenase-1-->PGE2

22

What protects the duodenum from acid?

Brunner's glands produce mucus with high buffer capacity
Also, biliary and pancreatic secretion have high bicarb

23

What are other risk factors for peptic ulcer disease?

Cigarette smoking (most important)
alcohol
coffee
psychological factors
Nsaids

24

How does misoprostol work?

It prevents NSAID ulcers. It's a PGE2 that enhances mucosal production and reduces acid secretion

25

Sulfated disaccarides

Sucralfate protects damaged mucosa

26

What are other ulcerogenic drugs?

Indomethacin

27

What are the side effects of tums?

Hypercalcemia can stimulate acid production, and release of gastrin

28

What are the side effects of aluminum hydroxide?

constipation, anorexia, weakness, and bond pain

29

What are the H2 receptor antagonists?

cimetidine, ranitidine, famotidine nizatidine

30

What are the side effects of cimetidine?

1. Mental confusion
2. Gynecomastia
3. Slows hepatic cytochrome P450 (higher levels of warfarin, diazepam, theophylline, phenytoin)

31

What are the side effects of ranitidine, famotidine, nizatidine?

DO NOT interfere with cytochrome P450
Less potent anti-androgen effects

32

When should you give a PPI?

Before the first meal of the day

33

How do PPIs work?

They accumulate in the secretory canaliculus and block the H/K ATPase.

34

What are the side effects of PPI?

VERY few! This is why it's the leading anti-acid. diarrhea and headache sometimes

35

What cocktail of drugs would you use to eradicate H pylori?

bixmuth, metronidazole, and tetracycline for 2 weeks

36

What is zollinger-ellison syndrome?

Also known as a gastrinoma, it results in hypersecretion of gastrin, and therefore hypersecretion of acid

37

What are the clinical features of ZES?

Severe peptic ulcers that are resistant to medical therapy. They have a high frequency of bleeding and perforations. Will also see diarrhea, steatorrhea because acidic gastric secretions increase fluid in gut and absorptive fxns.

38

Where are ulcers typically found in zollinger ellison?

Duodenum. If found in the jejunum, you KNOW this is ZES!!. Gastric ulcers are less common

39

What do you need to diagnose ZES?

HIGH gastrin levels, and positive secretin stimulation test if needed

40

What is the secretin test?

IV secretin normally suppresses gastrin release fro G cells. However, secretin will STIMULATE gastrin release in gastrinomas

41

What family of genetic disorders do you find ZES?

MEN1

42

Where are gastrinomas found?

duodenal wall, sometimes in the pancreas. Will often metastasize to the liver

43

what is the pathophysiology of acute stress ulcerations of stomach?

Linear shallow defects in gastric mucosa. Pts are hyposecretors of acid. But also gastric mucosa breaks down from stress. Seen in ICU patients

44

What is Cushing's ulcer?

Patients with intracranial trauma have HIGH acid secretion. Cushing's ulcer.