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