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Peptic Ulcer


Abd pain, indigestion, loss of appetite, N&V, and melena can be symptoms of: Gastritis
Causes of acute hemolytic gastritis (6) Stress lesions, drugs, trauma (foreign body, NG tube, radiation); embolism/vasculitis; reflux injury; H Pylori
Causes of non-erosive chronic gastritis chronic superficial H Pylori or chemical gastritis; metaplastic atrophic: autoimmune (AD, F>M 3:1, fundus/body) or environmental (H Pylori & diet)
Forms of gastritis (4) Infectious (CMV, HIV, herpes, fungal, TB, syphilis); sarcoid; eosinophilic; Crohns
H Pylori diagnostic tests (5) Serology. Bx w/histology. Bx w/urease test. Urea breath test. Stool antigen
H Pylori & ca causal: gastric adenoCa; assoc w/ MALT
ZE testing fasting gastrin level (>1000 is dx); secretin stim test (normal pt: no fx on gastrin; ZE pt: dramatic increase)
ZE tx HD PPI; resect if no mets (30-50%); mets: tx sx
ZE prognosis no mets: 15-yr 83%; mets: 10-yr 30%; fasting gastrin level prognostic
PUD sx Burning pain localized to the epigastrum, non-radiating; gastric ulcer: worse with meals; duod ulcer: better with meals, more often pain at night (wakes pt 2-3 AM)(DU>GU)
PUD dx EGD & bx (4% PUD become malig); HP test
PUD complications hemorrhage (Most Common); perf; gastric outlet obstruction
PUD tx antacids, H2 blockers, PPI
Acid secretion 3 stimuli of HCl prod in parietal cell: histamine, Ach, gastrin (synergistic); somatostatin is inhibitor
PPI AE Diarrhea, nausea, abdominal pain, HA; poss C diff; hip fx risk if used LT
PUD: surg rare; gastric patch or gastrectomy w/vagotomy
High risk for NSAID complications Previous GI event; Older Age; Concomitant use of anticoagulants, corticosteroids or other NSAIDs; HD NSAID tx
NSAID complication: prevention (2) COX-2 tx; Mucosal Protection (Misoprostol; PPI; High-dose H2 blocker)
What is misoprostol and what is its use in tx of ulcers? Synthetic PGE1 analog; prevent NSAID-induced gastric ulcers; sig reduction (GU > DU); AE abd discomfort & diarrhea; CI in women of childbearing age
Gastric cancer: early sxs Asymptomatic early (later: indigestion, nausea, early satiety, anorexia, wt loss)
Gastric ca etiology (5) Diet (pickled, salted foods, smoked meats); H pylori; atrophic gastritis; Polyps (rare); Radiation
Gastric ca: histology 95% adenocarcinoma; other: lymphoma, SSC
Gastric ca: imaging (4) EGD; EUS; Barium Swallow (Upper GI); CT/MRI
Gastric ca: Tx (3) Surgical resection (best chance for cure); Neoadjuvant chemo & XRT; Adjuvant chemo
PUD common anatomy: duodenal 5x more common than gastric; typically 5 mm diameter & extend through muscularis mucosae
PUD etiologies: H pylori, NSAIDs, hypersecretory peptic states
Benign gastrin-secreting tumor usually in pancreas resulting in uninhibited secretion of gastrin & acid production = Zollinger-Ellison
What percent of pts with H pylori will need re-tx after initial eradication tx? 20%
H Pylori eradication tx: quadruple tx PPI + bismuth + metronidazole + tetracycline
Post-tx, confirm eradication of H pylori with: stool antigen
H2 blocker AEs HA, nausea, abd pain, low platelets
rapid urease test sensitivity & specificity: sensitivity 90%; specificity 98%
If rapid urease test is negative, do: Histo stain
H pylori test that stays positive Serology
H pylori test used as test of cure Fecal Ag
Meds that can cause false-negative H pylori tests PPI (avoid x14 days prior to breath test), Abx, or bismuth gives false neg (except in serology or bx w/histo)
Common causes of gastritis NSAIDs, EtOH, stress, portal HTN
Tx for PUD/H pylori eradication Triple therapy: (PPI or H2 blocker) + clarithromycin + (amoxicillin +/- metronidazole) x 7-14 days
Multiple or constant GI ulcer pain despite medications may be due to: Zollinger-Ellison Syndrome
Burning, non-radiating epigastric pain; may be sx of: Peptic ulcer disease
H pylori infection (in body/fundus) resulting in acid hyposecretion can lead to: atrophic gastritis => intestinal metaplasia => gastric cancer
H pylori infection (in antrum) resulting in acid hypersecretion can lead to: duodenal gastric metaplasia => inflammation => ulceration
Tissue injury associated with H pylori is due to production of lipopolysaccharides, leukocyte-activating factors, and (2): CagA and VacA proteins
gastric ulcer: effect of eating on symptoms with meals Pain is worse
Duodenal ulcer: effect of eating Pain is better. More often pain at night (wakes pt 2-3 AM)(DU>GU)
Late complications in gastric cancer (5) Pleural effusion; gastric outlet/GE obstruction, SBO, bleed; palpable stomach; hepatomegaly; Virchow & Sister Mary Joseph nodes
In autoimmune atrophic gastritis, loss of parietal cells results in (3):
Created by: Abarnard
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