Week 2 Pre-Learning: GI Tract - PUD, Gastritis

Question 1

Why does peptic ulcer disease occur?

Answer 1

1. when ulcerative lesions are caused by exposure of the stomach or duodenal mucosa to HCL acid-pepsin secretions

Question 2

How do peptic ulcers occur? (2)

Answer 2

• GI mucosa is normally protected by mucous containing HCO3- and mucin
• Ulcers develop when there is excess acid or diminished mucosal defense

Question 3

What are the most common causes of PUD? (2)

Answer 3

• H. pylori infection
• NSAID use

Question 4

Aggressive and defensive factors of PUD diagram

Answer 4

Question 5

What percentage of people with PUD are infected with H. Pylori but do not develop ulcers?

Answer 5

up to 90%

Question 6

What percentage of chronic NSAID users will develop pressure ulcers?

Answer 6

• 20%

Question 7

What are the risk factors for PUD? (4)

Answer 7

1. Diet - lack of protective foods (fibre, vitamin A)
2. Smoking
3. Alcohol
4. Stress

Question 8

What is the function of prostaglandins related to ulcers and gastritis? (3)

Answer 8

1. Promotes secretion of bicarb and protective mucus
2. Suppress secretion of gastric acid
3. Maintains submucosal blood flow via vasodilation

Question 9

Why does chronic NSAID use cause PUD? (4)

Answer 9

• NSAIDS suppress prostaglandins, increasing the risk for peptic ulcers and GI bleeding (GIB) by:
  1. Decrease in that protective mucous production and decrease in neutralizing bicarb
  2. Increased production of gastric acid
  3. Decreased blood flow to the GI submucosa due to vasoconstriction

Question 10

What are the symptoms of PUD? (2)

Answer 10

• can be asymptomatic
• pain is described as burning

Question 11

What is a symptom for gastric ulcers?

Answer 11

• gaseous in epigastric area 1-2 hours after eating

Question 12

What is a symptom for duodenal ulcers?

Answer 12

cramp-like in midepigastric or back pain, 2-4 hours after eating

Question 13

What are three complications of PUD?

Answer 13

• Hemorrhage
• Perforation
• Gastric outlet obstruction

Question 14

What is a hemorrhage caused by?

Answer 14

• due to erosion of granulation tissue at base of ulcer (more common in duodenal ulcer)

Question 15

What are symptoms of a hemorrhage? (3)

Answer 15

• hematemesis
• Melena
• occult bleeding

Question 16

What is a perforation in relation to PUD?

Answer 16

• ulcer penetrates serosal surface and gastric/duodenal contents enters peritoneal cavity (peritonitis)

Question 17

What is a gastric outlet obstruction?

Answer 17

• Ongoing inflammation can cause obstruction of gastric outlet

Question 18

What are the symptoms of a gastric outlet obstruction? (2)

Answer 18

• belching
• projectile vomiting

Question 19

What is gastritis?

Answer 19

• Inflamed stomach mucosa with significant risk of GI bleeding (especially in hospitalized patients)

Question 20

What are the causes of gastritis? (5)

Answer 20

• alcohol
• NSAIDS
• H. Pylori
• Crohn’s disease
• stress (ie. major surgery)

Question 21

What are the clinical manifestations of gastritis? (5)

Answer 21

often asymptomatic but can have:
- anorexia
- N+V
- Epigastric tenderness
- feeling of fullness

Question 22

What are complications of gastritis?

Answer 22

bleeding

note that gastritis does not mean you will have PUD