pud Flashcards
pud (85 cards)
1
Q
What are peptic ulcers?
A
Focal defects in the gastric or duodenal mucosa that extend into the submucosa or deeper
They may be acute or chronic and are more common in males than females.
2
Q
What is the male to female ratio for peptic ulcers?
A
3-4:1
3
Q
Where are the most common sites for peptic ulcers?
A
First part of the duodenum and the lesser curvature of the stomach
4
Q
What does the term ‘peptic’ suggest about ulcers?
A
An association with pepsin
5
Q
What is the definition of an ulcer?
A
Break of the continuity of the epithelium
6
Q
What is the estimated lifetime prevalence of peptic ulcers?
A
10%
7
Q
How much earlier does duodenal ulcer (DU) emerge compared to gastric ulcer (GU)?
A
10-20 years earlier
8
Q
What is the ratio of duodenal ulcers to gastric ulcers?
A
3:1
9
Q
What characterizes Type 1 ulcers?
A
Ulcer along the body of the stomach, mostly along the lesser curve at incisura angularis, not associated with acid hypersecretion
10
Q
What characterizes Type 2 ulcers?
A
Ulcer in the body of the stomach in combination with duodenal ulcer, associated with acid over-secretion
11
Q
What characterizes Type 3 ulcers?
A
Located in the pyloric canal within 3 cm of pylorus, associated with acid over-secretion
12
Q
What characterizes Type 4 ulcers?
A
Proximal gastroesophageal ulcer, associated with hypoacidity
13
Q
What characterizes Type 5 ulcers?
A
Can occur in any location, associated with chronic use of NSAIDs
14
Q
What demographic is more common for duodenal ulcers?
A
Middle age, peak from 30 to 50 years
15
Q
What blood group is commonly associated with duodenal ulcers?
A
Group O
16
Q
What is a significant risk factor for duodenal ulcers?
A
H. pylori infection
17
Q
How does the pain from duodenal ulcers typically present?
A
Epigastric hunger pain or discomfort occurring 2 to 4 hours after a meal or at night
18
Q
What typically relieves the pain caused by duodenal ulcers?
A
Antacids or eating
19
Q
What is a common feature of gastric ulcers?
A
Risk of being malignant
20
Q
At what age do gastric ulcers typically become more common?
A
> 50 years
21
Q
What blood group is more common in patients with gastric ulcers?
A
Blood group A
22
Q
What is the male to female ratio for gastric ulcers?
A
2:1
23
Q
What percentage of patients with gastric ulcers have a concomitant duodenal ulcer?
A
10-20%
24
Q
What are considered atypical ulcers?
A
Giant ulcers (DU >2cm, GU >3cm), post bulbar ulcers, multiple ulcers
25
What causes peptic ulcer disease (PUD)?
Imbalance between defensive and aggressive factors of GIT
26
List defensive factors of the gastrointestinal tract.
* Mucus secretion
* Prostaglandins secretion
* Huge stomach mucosal blood flow
* Bicarbonate secretion from the duodenum
27
List aggressive factors that contribute to PUD.
* Helicobacter pylori infection
* NSAIDs & Aspirin
* Acid/Pepsin hypersecretion
* Smoking
* Genetics
* Psychological factors
* Zollinger-Ellison Syndrome
28
What is the most common cause of PUD?
H. pylori infection (70-85% of PUD cases)
29
Who identified H. pylori and when?
Barry Marshall and Robin Warren in 1982
30
What is the role of urease produced by H. pylori?
Breaks down urea in the stomach to harmful compounds like CO2 and ammonia
31
What do NSAIDs do to contribute to PUD?
Inhibit synthesis of prostaglandins, reduce bicarbonate and mucus secretion, impair mucosal blood flow
32
What effect does smoking have on peptic ulcers?
Increases incidence, delays healing, and increases relapse and complications
33
What is Zollinger-Ellison Syndrome?
A rare disorder resulting in excessive gastric acid production, causing peptic ulcers
34
How is Zollinger-Ellison Syndrome diagnosed?
Gastric secretory test: basic acid output >15mEq/hour and fasting serum gastrin level >5000pg/ml
35
What is the treatment of choice for H. pylori?
Triple therapy for 14 days including two antibiotics with an antacid
36
Name the components of the triple therapy for H. pylori.
* Proton pump inhibitor
* Clarithromycin
* Amoxicillin
37
List some proton pump inhibitors that can be used.
* Omeprazole
* Lansoprazole
* Rabeprazole
* Esomeprazole
38
What is the typical dosage for Omeprazole in H. pylori treatment?
20mg PO bid for 14 days
39
What is the typical dosage for Clarithromycin in H. pylori treatment?
500mg PO bid for 14 days
40
What is the typical dosage for Amoxicillin in H. pylori treatment?
1g PO bid for 14 days
41
What is the dosage of Rabeprazole (Aciphex) for treating peptic ulcers?
20 mg PO bid for 14 days.
42
What is the dosage of Esomeprazole (Nexium) for treating peptic ulcers?
40 mg PO qd for 14 days.
43
What additional medications are prescribed alongside Rabeprazole or Esomeprazole?
* Clarithromycin (Biaxin): 500 mg PO bid for 14 days
* Amoxicillin (Amoxil): 1 g PO bid for 14 days
44
How long should proton pump inhibitor therapy continue in the setting of an active ulcer?
For an additional 2 weeks.
45
Who should consider prophylactic therapy for NSAID-induced ulcers?
* Patients with NSAID-induced ulcers requiring daily NSAID therapy
* Patients older than 60 years
* Patients with a history of PUD or complications like GI bleeding
* Patients taking steroids or anticoagulants
* Patients with significant comorbid medical illnesses
46
What prophylactic regimens can reduce the risk of NSAID-induced ulcers?
* Prostaglandin analogue
* Proton pump inhibitor
47
What is the dosage of Misoprostol (Cytotec) for prophylactic therapy?
100-200 mcg PO 4 times per day.
48
What is the dosage of Omeprazole (Prilosec) for prophylactic therapy?
20-40 mg PO every day.
49
What does b.i.d. stand for in medical prescriptions?
Twice (two times) a day.
50
What are the preferred diagnostic tests for Peptic Ulcer Disease (PUD)?
* Rapid urease test
* Testing for H. pylori
* Upper GI endoscopy
51
What can Upper GI endoscopy diagnose in patients with PUD?
Ulcers and allows for biopsy to rule out malignancy.
52
What laboratory tests are useful in diagnosing complications of PUD?
* Stool for fecal occult blood
* CBC to rule out bleeding
* Liver function test
* Amylase
* Lipase
53
How can H. pylori be diagnosed?
* Urea breath test
* Blood test
* Stool antigen assays
* Rapid urease test on a biopsy sample
54
What lifestyle changes can help reduce PUD?
* Discontinue NSAIDs
* Use Acetaminophen for pain control
* Acid suppression (Antacids)
* Smoking cessation
* Alcohol in moderation
* Stress reduction
55
What are common complications of peptic ulcers?
* Perforation
* Penetration into adjacent organs
* Bowel obstruction
* Bleeding
* Intractable disease
56
What is the most common complication of peptic ulcer?
Perforation.
57
What is the typical presentation of perforation from a peptic ulcer?
Sudden severe diffuse epigastric abdominal pain and fever with signs of peritonitis.
58
What bacteriology is associated with perforation in the first 48 hours?
* 50% sterile peritonitis
* 50% gram-positive peritonitis
59
What imaging can be used to investigate perforation?
* Standing chest X-ray
* Lateral decubitus X-ray
* CT scan of abdomen and chest with oral gastrografin contrast
60
What is the treatment approach for perforation of a peptic ulcer?
* Resuscitation
* Conservative treatment (IV fluids, NG tube, prophylactic antibiotics)
* Surgery (closure and lavage)
61
What are bad prognostic features in perforation cases?
* Diagnosis 48 hours after onset of symptoms
* Perforation with shock
* Large ulcer
* Medical comorbidities
* Advanced age (>75)
62
What is the historical significance of H. pylori in the context of peptic ulcers?
It was discovered to be the most common cause of PUD, changing treatment strategies.
63
What is Graham's omental patch surgery?
A procedure for closing perforated duodenal ulcers using omental tissue.
64
What are the morbidity and mortality rates associated with omental patch surgery?
* Morbidity: 13-23%
* Mortality: 0-8%
65
What is the primary blood supply to the stomach?
* Celiac trunk
* Left gastric artery
* Common hepatic artery
* Splenic artery
66
What is the most common cause of upper GI bleeding?
Peptic ulcer disease (PUD).
67
What are the symptoms of upper GI bleeding?
* Hematemesis or coffee-ground emesis
* Melena (black tarry stool)
* Hematochezia (maroon or bright red blood per rectum)
68
What is the management goal for upper GI bleeding?
* Stabilize circulation
* Stop ongoing bleeding
* Prevent re-bleeding
69
What does endoscopy aim to achieve in cases of upper GI bleeding?
Identify the cause and treat it.
70
What classification is used for ulcers based on endoscopic appearance?
Forest Classification.
71
What is the purpose of endoscopy in the context of UGIB?
To know the cause of UGIB and treat it
## Footnote
Endoscopy serves both diagnostic and therapeutic functions.
72
What are the indications for surgery in cases of bleeding ulcers?
Indications include:
* A patient who took three units of blood and the bleeding didn’t stop
* Continuous bleeding after endoscopy
* Rebleeding after surgery
* Hypovolemic shock due to bleeding
* Slow bleeding (3 units of blood per day)
## Footnote
These indications highlight critical situations where surgical intervention is necessary.
73
What are the two types of stenosis in gastric outlet obstruction?
Reversible and irreversible
## Footnote
Stenosis can lead to significant complications in patients with PUD.
74
What are the common symptoms of gastric outlet obstruction?
Symptoms include:
* Projectile vomiting
* Non-specific epigastric pain
* Weight loss
* Anorexia
* Nausea
* Bloating
* Indigestion
* Early satiety
* Positive succussion splash
## Footnote
These symptoms are crucial for identifying G.O.O.
75
What does a positive succussion splash indicate?
It indicates intestinal or pyloric obstruction
## Footnote
This sound is elicited by shaking the abdomen and is associated with free fluid and gas.
76
What is the pathogenesis of gastric outlet obstruction?
Starts as a reversible inflammatory process, leading to fibrosis and scarring, and can progress to irreversible atony
## Footnote
Understanding the pathogenesis helps in determining treatment strategies.
77
What investigations are used for diagnosing gastric outlet obstruction?
Investigations include:
* Gastric reseal test
* Saline loading test
* Upper GI endoscopy
* Upper GI radiography
* CT scan with oral contrast
## Footnote
These tests help confirm the diagnosis and assess the severity of the obstruction.
78
What is the initial treatment for reversible gastric outlet obstruction?
Conservative treatment including:
* Stabilizing the patient hemodynamically
* NG suction
* IV fluids
* Monitoring electrolytes and urine output
* Administering IV PPI
## Footnote
About 50% of patients may respond to conservative treatment.
79
What is dumping syndrome?
A complication of gastroduodenostomy where ingested foods bypass the stomach rapidly and enter the intestine largely undigested
## Footnote
This condition can lead to various gastrointestinal symptoms.
80
What are the symptoms of early dumping syndrome?
Symptoms include:
* Nausea
* Vomiting
* Bloating
* Cramping
* Diarrhea
* Dizziness
* Fatigue
## Footnote
These symptoms occur within 15 to 30 minutes after eating.
81
What characterizes late dumping syndrome?
Symptoms include:
* Weakness
* Sweating
* Dizziness
## Footnote
Late dumping occurs one to three hours after eating.
82
What is alimentary hypoglycemia?
Hypoglycemia triggered by rapid dumping of food, leading to excessive insulin release
## Footnote
This condition is often seen in patients with dumping syndrome.
83
What is the next step after a patient presents with hematemesis and melena?
Upper GI endoscopy
## Footnote
Both hematemesis and melena are signs of upper GI bleeding, making upper GI endoscopy the most diagnostic tool.
84
Which of the following is not a cause of UGIB? colonic diverticulosis, peptic ulcer, Mallory Weiss syndrome?
Colonic diverticulosis
## Footnote
Colonic diverticulosis is associated with lower GI bleeding.
85
Which is not a complication of gastrectomy?
All of these are true complications
## Footnote
Complications include wound infection, stricture, chest infection, internal bleeding, and vitamin deficiency.
