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Peptic Ulcer Disease
Terms in this set (30)
Most common causes of Peptic Ulcer Disease
-H. pylori Infection
-Chronic NSAID use
-Acid Hypersensitivity states (e.g. Zollinger-Ellison)
What are the Clinical features of PUD
-Epigastric pain --> aching or gnawing in nature
What is the most accurate test for diagnosing peptic/duodenal ulcers? What are other modalities for diagnosis?
1) Endoscopy is most accurate
2) Can use barium swallow but it has lower reliability
In what situation is endoscopy the preferred imaging modality? Why?
Severe bleeding b/c we can perform electrocautery on bleeding ulcers
What are the advantages of endoscopy?
-Can obtain biopsy of gastric ulcer to r/o malignancy
-Can obtain biopsy for diagnosis of H. pylori
What laboratory tests can be used for PUD?
-Mainly for diagnosis of H. pylori
--Biopsy = gold standard for Hp
--Urea breath test for urease = most convenient test
--Serology = lower specificity; will detect previous Ab to Hp and not current infection
-Can test for Serum Gastrin levels if considering ZE diagnosis
What is the best initial step in an
If ulcer is
then you can start empiric treatment with PPIs
going thru endoscopy or barium study.
H. pylori causes _____% of duodenal ulcers and _____% of gastric ulcers?
70%-90% of duodenal ulcers
60%-70% of gastric ulcers
What is the most common location of a peptic ulcer? What are the other locations?
Type I (most common) = lesser curvature
Type II = gastric and duodenal ulcer
Type III =prepyloric (w/in 2 cm of pylorus)
Type IV = Near EG junx
Age distribution of duodenal vs gastric ulcer?
Duodenal = younger patients (<40 yo)
Gastric Ulcers = older patients (>40 yo)
Risk Factors for duodenal ulcer? gastric ulcer?
DU = NSAIDs
GU = Smoking
Effect of eating on duodenal vs gastric ulcer?
Malignancy potential for duodenal vs gastric ulcer?
DU = low (malg rare), but still want bx to r/o malg
GU = High (5%-10%), always want bx
DU vs GU picture from Kaplan
What is supportive treatment for PUD?
-D/C ASA, NSAIDs
-Avoid eating before bedtime
-Decrease coffee intake
What is the treatment regiment for H. pylori infection?
- Start Triple or Quadruple therapy and begin acid suppression with antacids, H2 blocker or PPI
= PPI plus amoxicillin and clarithromycin
= PPI, bismuth subsalicylate, metronidazole, and tetracycline
What are the pros and cons of triple vs quad therapy for Hp infx?
-Triple therapy is cheaper, but takes twice as long
-Quad therapy is shorter (one week vs two weeks with TT), but is more expensive
What is treatment regiment for active NSAID-induced ulcer?
-Stop NSAID use (switch to acetaminophen) and begin with either PPI or misoprostol. Continue for 4-8 weeks, depending on severity
-Treat Hp if present
When should antisecretory drugs be d/c'd?
4 to 6 weeks; maintenance therapy may be needed if patient at increased risk for recurrence
When is surgery indicated for PUD?
-Complications of PUD
--Gastric Outlet obstruction
Treatment for refractory PUD?
56 yo Woman epigastric pain unresponsive to several weeks of PPI, Clarithromycin, and amoxicillin. What is most appropriate next step?
What are three main complications of PUD?
2) Gastric Outlet Obstruction
3) GI Bleeding
What are the clinical findings of Perforation of PUD? Diagnostic Findings?
Clinical: Acute severe abdominal pain, signs of peritonitis, hemodynamic instability
Diagnostic: Free air under diaphragm on Upright CXR
What is the management of Gastric Outlet Obstruction?
1) Initially, NG suction
2) Replace electrolyte/volume deficits.
3) Supplement nutrition if obstruction is longstanding
4) Sx is eventually necessary in 75% of patients
What are the clinical findings of GI bleeding? diagnostic findings?
Clincial: Bleeding may be slow --> leading to
-or- can be rapid --> leading to
Diagnostic: Stool guaiac, upper GI endoscopy
What is the management of GI bleeding?
2) Diagnose site of bleed via endoscopy and treat
3) Perform Sx for acute bleeds that require transfx of >6 units of blood
What is management of PUD Perforation
emergency surgery to close perforation
Non-ulcer dyspepsia etiology
Best initial therapy for non-ulcer dyspepsia
THIS SET IS OFTEN IN FOLDERS WITH...
PEPTIC ULCER DISEASE
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