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DU PA Peptic Ulcer

Duke PA Peptic Ulcer Disease

inflammation of gastric mucosa gastritis
S and S of gastritis ab pain, indigestion, loss of appetite, N/V, melena
develops shortly after exposure to insult, petechial hemorrhages and small erosions acute hemorrhagic gastritis
causes of acute hemorrhagic gastritis stress lesions, drugs (NSAIDS, alcohol, corrosives, trauma, radiation, H. pylori
H. pylori can cause both acute and chronic gastritis
__ is helpful if specific cause unknown biopsy
lifetime PUD prevalence is __% 11-14
the three most important etiologic factors for PUD H. pylori, NSAIDS, Acid
H. pylori is more common in __ blacks and hispanics
H. pylori lives in the gastric mucous layer adjacent to the epithelial surface
adaptations of H. pylori urease production provides buffering, residenc in mucus layer, creates ionic gradient at low pH
concurrent use of __ will cause false negative results except on H. pylori serology or biopsy w/ histology PPI, antibiotics, or bismuth
triple therapy for H. pylori eradication PPI (prevacid), clarithromycin, Amoxicillin
confirmation of eradication of H. pylori urease breath or blood test or stool test
__ is no the first line treatment for H. pylori eradication b/c of resistance flagyl
H. pylori is associated with gastric adeno carcinoma, and MALT (mucosa associated lymphoid tissue) lymphoma
is the syndrom associated with a gastrinoma (gastrin secreting tumor) Zollinger-Ellison Syndrome
MEN I parathyroid, pancreas, and pituitary tumors
clinical findings in Zollinger-Ellison PUD-majority in duodenal bulb, usually resistant to treatmen, Gerd, Diarrhea-volume load of acid, acid inactivates pancreatic enzymes, causes steatorrhea
PPI's increase the amount of __ secreted gastrin
very sensitive and specific test for gastrinoma Secretin stimulation test
secretin has no effect on __ in normal patients but dramatically increases levels in ZE patients gastrin
treatment of gastrinoma high dose PPI, surgical resection if not metastatic
without metastasis 15 year survival rate of gastrinoma is __% 83
burning pain localized to the epigastrum , non radiating that gets worse with meals gastric ulcer
burning pain localized to the epigastrum, non-radiating that gets better with meals duodenal ulcer
most discriminating symptom of PUD is the presence of pain that awakens the patient from sleep between 2-3 am
__ allows characterization of the lesion and biopsy which is important since about 4% of GU are cancerous EGD
most common complication of PUD hemorrhage
occurs in 15% of PUD patients and 2% of NSAID users hemorrhage
perforation occurs in __% of PUD patients 7
treatment for PUD antacids, H2 blockers, proton pump inhibitors
three principal stimuli of HCl secretion via the parietal cells histamine, acetylcholine, gastrin
principle inhibitor of HCl secretion via parietal cells is somatostatin
less effective than PPI's H2 blockers
blocks parietal cell H+/K+ ATPase pump PPI's
stomach can be rendered anchlorhydric with __ use PPI
PPI's are most effective when taken __ min before meals 15-30
increased risk of __ with long term use of PPI's hip fracture
side effects of PPI's diarrhea, nausea, abdominal pain, HA
who is high risk for PUD from NSAID use previous event, older age, also on anticoagulants/corticosteroids/other NSAIDS, high dose NSAIDS, chronic disease
strategies for preventing NSAID complications Cox-2 therapy, Mucosal protection (misoprostol, PPI, High dose H2 blocker)
synthetic prostaglandin E1 analog, prevention of NSAID-induced gastric ulcers, not for use in women of childbearing age misoprostol
most common cause of PUD in US H. pylori, and NSAIDS
think of __ in cases of multiple ulcers or refractory ulcers Zollinger-Ellison
__ are most effective in prevention of gastrodudenal toxicity with NSAIDs PPI's and Misoprostol
Created by: bwyche