Petic Ulcer Disease PUD Flashcards
State the alarm symptoms
Bleeding in stool or anemia
Unexpected weight loss
Dysphagia D for difficulty
Odynophagia O for ouch
Vomiting
What are the 3 most common cause for PUD
H. Pylori
NSAID use
Stress
What pts do you test for H. Pylori
Active PUD symptoms
PMH of PUD
History endoscopic resection of early gastric cancer
DO NOT TEST GERD with no PMH of PUD
do we treat H. Pylori empirically
NO
What constitutes cure of H. Pylori
No detection 4 week post therapy and 1-2 weeks after PPI stopped
Non pharm treatment for H. Pylori
Avoid smoking
Avoid trigger foods
Refrain from eating 2-3 hours of lying down (sleep on left side)
Probiotic (Lactobacillus and bifidobacterium x H. Pylori ) - Limited efficacy
GERD Pillow
What do we consider before starting H. Pylori treatment
True penicillins allergy
Previous on any macrolide or any clarithromycin resistance
What are the first line therapies for H. Pylori
Bismuth quad - please make tummy better
Concomitant
Clarithromycin triple w/ amox
Clarithromycin triple w/ metronidazole
Levofloxacin triple
What treatment is “ Please make tummy better”
Bismuth quad
PPI (Please) + metronidazole (make) + tetracycline (tummy) +bismuth sub (better)
What is the treatment “Please make cake again”
concomitant
PPI (please) + Metronidazole (make) + clarithromycin (cake) + amoxicillin (again)
What are the three triple regiments for H. Pylori
Clarithromycin triple w/ amoxicillin - ( PPI + clar +amox)
Clarithromycin triple w/ metronidazole
Levofloxacin triple (PPI - levofloxacin + amoxicillin
What therapy is your salvage therapy for H. Pylori
Levofloxacin triple and sequential
What therapy is usable across all h. Pylori
Bismuth quadruple
Key question picture for h. Pylori
Dosing for H. Pylori first line regiments
