PUD

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Answer

what are the three most common causes of PUD

helicobacter pylori infection, nonsteroidal anti inflammatory drugs, critical illnes (stress related muscosla damage) SRMD

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uncommon causes of PU are

* Zollinger- Ellison's hypersection of gastric acid, *viral, vascular insufficiency (crack), *radiation, chemo, genetic, idopathic

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the most important cofactors in PU formation is

alterations in mucosal defense induced by HP or NSAIDS.

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Mucosal defense and repair mechs are

mucus, bicarb secretion, intrinsic epithelia cell defense, and mucosal blood flow.

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what maintanes mucosal integrity and repair and is ofter disrupted by causes of PU

endogenous prostaglandin production

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HP cause ulcers by three mechanism which are

direct mucosal damage, altering the immune/inflammatory response, and by hypergastrinemia leading to increase acid secrection

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NSAIDS cause gastric mucosal damage by which to mechanism

direct or topical irritation of gastric epithelium, and systemic inhibition of the cyclooxygenase-1 enzyme to synthesises the protective prostaglandins

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smoking, alcohol, stress, coffee, tea, cola, beverages, spices may cause dyspepsia but there is

no cause effect relaitonship but these factors prevent healing and cause irritation and exsarbate the pain

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what is the most frequent symptom of PUD, where is it located, and how is it described

abdominal pain, epigastric and described as burning but can present as vague discomfort, abdominal fullness, or cramping. Nocturnal pain is often reported.

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how do you tell the difference between a DU and GU by symptoms alone

food usually aleveates DU ulcers and pain occurs 1-3 hours after meals while GU patients complain of food precipitating ulcer. nausea, vomiting, and anorexia are more common in GU than DU

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Factors that can be significant to both GU and DU's are

antacids relieve both, hearburn, belching, and bloating

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what are the four most common complications of both HP an NSAIDs ulcers

upper GI bleeding, perforation into the peritoneal cavity, penetration into an adjacent structure such as pancreas, biliary tract, or liver, and gastric outlet obstruction.

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How might bleeding present in an ulcer complication

occult(hidden) and insidious, or may present as melena (black-colored stools) or hematemesis (vomiting of blood). The use of NSAIDs (especially in older adults) is the most important risk factor for upper GI bleeding.

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does smoking increase your risk of ulcer reocurance after HP eradication

Smoking does not increase ulcer recurrence after HP eradication.

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most accurate noninvasive test.

he UBT tests for active H. pylori infection

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require that the patient ingest radiolabeled urea, which is then hydrolyzed by H. pylori (if present in the stomach) to ammonia and radiolabeled bicarbonate.

The 13carbon (nonradioactive isotope) and 14carbon (radioactive isotope) tests. 14carbon is measured by using a scintillation counte

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which test is absorbed in the blood and excreted in the breath.

The radiolabeled bicarbonate UBT

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which tests are a cost-effective alternative for the initial diagnosis of H. pylori infection.

The serologic antibody tests

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identifies H. pylori antigens in the stool by enzyme immunoassay. It is less expensive and easier to perform than the UBT and may be USEFUL IN CHILDREN. may be less accurate when used to document eradication post treatment.

The fecal antigen test identifies H. pylori antigens in

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Which noninvasive test are for children an which shouldn't be used in children

serolgic antibody detection test is not reliable in children but the stool antigen is useful in children

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which two nonendoscopic tests should not be used for eradication conformation

antibody and antigen tests

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what test is not affected by PPI use for detection

antibody

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which tests may cause fause positives when used along side PPI , H2RA's adn antibiotics

urea breath test and stool antigen

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which test(s) are unable to determine if the infection is current or was sometime in the past

antibody detection test (lab and in office) don't get confussed the antigen test can test for active or not

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if the UBT test is prefered, how long must the patient be off PPI and H2RA and bismuth and antibiotics before this test can be used

Urea breath test. Therefore can't confrim erradication until 4 weeks later because test is not as senstivie adn specific before then.

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when is culturing the biopsy appropriate treatment and when is it not

not recommended for initial diagnois; used after failure of second line treatment

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what is the gold standard for the detection of HP? is it recommended for initial diagnosis

endoscopic tests with microbiological examination using various stains. Not recommended for intial diagnosis

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which test is of choice during an endoscopy

biopsy with rapid urease. the HP urease generates ammonia, which causes a color change.

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Created by: lainylaina