Ulcer Flashcards
Lesions > 3mm in the lining of the stomach or duodenum that may extend a variable distance into the muscle layer
Ulcer
What are the two main locations for ulcers?
Duodenal and gastric
What is the number of new cases of ulcers in the US each year?
500,000
The lifetime risk for ulcers is between ___ - ___%
10-17%
Ulcers are 2x as common in (men / women)
Men
_____ ulcers are 4x more common overall
Duodenal
Duodenal ulcers are more common between the ages of ___ - ___
30-55
Gastric ulcers are more common after the age of
55
With a chronic H. pylori infection, 1 in ___ people develop an ulcer, while ____% over the age of 60 are infected
1 in 6 infected; 60% over the age of 60
Excessive NSAID use increases the risk of developing ulcer by ____-fold.
40 fold
Excessive NSAID use contributes to what percentage of gastric and duodenal ulcers, with which NSAID being the most problematic?
10-20% gastric
2-5% duodenal
Aspirin is most problematic
What factor causes gastric hyperacidity?
Zollinger-Ellison syndrome (same as in GERD)
What are 6 general factors that increase the risk of developing a peptic ulcer?
- Smoking
- Chronic diseases (COPD, Crohn’s, Lymphoma, RA, cirrhosis)
- Medications (alendronate)
- Infections (CMV)
- Stress
- Alcohol
_____, ______, and _____ agonists increase the amount of gastrin that is secreted, which allows the cell to expand and release large amounts of gastrin
Muscarinic, histamine, and gastrin agonists
What is the underlying pathophysiology of ulcers?
Impairment of normal GI defenses and/or increased acid secretion
How does H. pylori contribute to gastric ulcers? (3)
- Decreases acid secretion
- Release of toxins and enzymes
- Chronic inflammation
* H. pylori burrows into lining and degrades mucosa, which causes release of cytokines and inflammatory response
How does H. pylori contribute to duodenal ulcers? (2)
- Increased acid secretion
2. Decreased bicarbonate synthesis
Main takeaway from H. pylori causing gastric ulcer
Mucosa lining becomes more permeable to acid due to bacteria degrading lining
Main takeaway from H. pylori causing duodenal ulcer
Increased acid secretion and decreased bicarbonate secretion, so acid is more likely to penetrate across mucosal barrier
How do NSAIDs contribute to the development of ulcers
Block COX-1 and COX-2, and COX-1 is needed to produce protective mucus from prostaglandins
(Also slightly increase acid secretion)
Clinical presentation of ulcers includes
- Pain (dull, burning, aching)
- Mild tenderness with palpation
- Nausea
- Anorexia
Typically, pain is relieved by ____ and ____, but often recurs during the _____.
Relieved by food and antacids; recurs during the night
____ ulcers are more likely to be relapsing-remitting
Duodenal
Procedure used as an ulcer patient assessment
Upper endoscopy
