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53 Cards in this Set
- Front
- Back
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what is the epidemology of PUD?
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500K per yr
men>women 70% between 25-65 y.o. |
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what is more common duodenal ulcers or gastric ulcers?
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duodenal ulcers are 3x more common
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in pt's without h. pylori what is the most common cause of ulcers?
-steroids -nsaid's -stress |
nsaid's
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what percentage of ulcers bleed?
-5-10% 10-15% 15-20% |
15-20% of ulcers bleed
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nsaid use is involved in what percentage of perforated ulcers?
-25% -50% -75% |
50% of perforated ulcers have to do with nsaid use
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eliminiation of h. pylori reduces the recurrence rate of ulcers by ?
-25% -50% 60% |
50%
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__ ulcers are 3 x's more common than __ ulcers
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duodenal ulcers are 3 x more common than gastric ulcers
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H. pylori is the major cause in 48% of __
PUD gastric ulcer dx duodenal ulcer dx |
PUD
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does smoking slow gastric emptying or increase gastric emptying?
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slow gastric emptying
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the consumption of etoh and coffee, __ gastric secretion release
increase decrease |
etoh and coffee increase the release of gastric secretions
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why are most people in ICU's on a PPI?
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most all surgical, burn, hypovolemic, critical pt's end up with gastro-duodenal erosions
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what is a neruo-endocrine tumor of the pancreas which secretes excessive gastrin which stimulates stomach to produce excessive acid leading to ulcers that can be malignant?
-Bence Jones syndrome -sigfried and roy syndrome -zollenger-ellison syndrome |
zollenger ellison syndrome
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what are the special features of H. pylori? its....
flagella lippolysaccharide enzymes |
the flaggela give it motility
lipopoly-allow it to adhere enzyme (urease) produce a strong base that neutralize acid enzyme (mucinase) cause gastric mucosal injury which detroys the gastric epithelial cells are exposed to stomach acid |
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__ is associated with GI mucosal integrity.
-prostaglandins -cox 1 -cox 2 |
prostaglandins are assoc with GI integrity
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traditional NSAID's interrupt the conversion of what to prostaglandins?
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arachnoid acid
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nsaid interrruption of the traditional arachnoid acid to prostaglandins via the ???
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cox 1-2 pathways
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what are some common d/d of PUD?
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gerd
pancreatitis gastritis (nonulcerative) hiatal hernia crohn's dx gastric ca cad/angina cholecystitis |
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what is the pain of PUD described like?
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gnawing
worse at night or on empty stomach relieved by food or antacids |
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pt's frequently c/o many things what are they?
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burping, belching, heartburn
intolerance of coffee/etoh epigastric pain to palpation |
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what suggests PUD bleed?
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coffee ground emesis
melena anemia orthostatic hypotension |
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diffuse abd. pain, abdominal rigidity, rebound tenderness that is worse with movement, fever suggests perforation and peritonoitis which = ???
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acute abdomen
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if a pt arrives to the er c/o vomiting up coffee grounds, and pooping melena, this is suggesstive of what condition?
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bleeding ulcer
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in a younger pt with no alarming symptoms what test can you run to r/o h. pylori?
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test for h. pylori and treat
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if a 60 y.o. male presents with gnawing epigastric pain and melena, what is the test of choice?
hpylori egd colonoscopy |
egd
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a fingerstick h pylori test is...
-qualitative -quantitative |
qualitative
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an ELISA test for Hpylori is...
-qualitative -quantative |
quantitative
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which has a higher false + rate?
egd upper gi |
upper gi
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if a pt. fails emperic tx for PUD what should the test of choice be?
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egd
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if the pt tests positive for h. pylori you must use ?
mono therapy double therapy triple therapy |
triple therapy
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what does triple therapy include?
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2 antibiotics and an acid suppressor (ppi or h2 blocker)
usually given for 2 weeks |
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what are 2 good triple therapies for the use in PUD?
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amoxil + clarithro + prevacid
or flagyl + tetra + bismuth + h2 blocker (zantac) |
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how long are ppi's usually continued for?
2 weeks 3 weeks 4 weeks |
4 weeks
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which may have greater efficacy?
ppi h2 blocker |
ppi
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if the pt has gi complaints but their h pylori is negative, what can you treat their symptoms with?
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ppi x4 weeks
h2 block x 4 weeks sulcralfate x4 weeks |
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if the pt has evidence of
GI bleeding and is hemodynamically stable? how do you treat? |
IV PPI
test for h pylori tx for h pylori perform egd |
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if an unstable pt has evidence of bleeding and is not hemodynamically stable, how do you treat?
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ABC's, IV O2, monitor
fluid resusitatin with NS or rbc's urgent EGD with ligation, epinephrine or sclerosing agent |
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plyoric stenosis can be due to inflammation, edema, scarring and fibrosis from the ulcers, all combined =
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gastric outlet obstruction
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do spicy foods cause ulcers?
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no
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does coffee, etoh, and cigarettes cause ulcers?
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yes
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what is the #1 cause of ulcers in the US?
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h. pylori
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nsaids are responsible for how many cases of PUD in the US?
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2nd most common cause, 24% of all cases
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what is a neuro-endocrine tumor of the pancreas which excretes excessive gastrin and then stimulates the stomach to procude excessive acid leading to sometimes malignant ulcers?
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zollenger-ellison syndrome
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what are the _ for?
flaggela lipopoly's urease mucinase |
flagella = motility
lipopoly's = adherence urease = strong base, that neutralizes acid mucinase = cause gastric mucosal damage |
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urease makes a _ environment
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basic, neutralizes acid
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what is the only cox-2 inhibitor?
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celebrex
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prostaglandins/cox 1 are associated with?
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gi mucosal integrity
plt function renal function |
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what is levines sign?
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sign of angina, grasping over the heart
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intense generalized, diffuse abdominal pain, abdominal rigidity, rebound tenderness, that is worse with movement and fever is suggestive of what ?
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perforation and peritonitis
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coffee ground emesis, melena, anemia, and orthostatic hypotension are indicative of what?
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a bleed
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other than a finger stick test and quantitative h pylori test what other methods of testing are available?
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urea breath test
stool antigen test histological test with endoscopy biopsy |
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t/f
an upper gi has higher false +'s and false -'s than an egd |
true
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what 3 things should any pt with h pylori stop?
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coffee
etoh smoking |
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do cigarettes cause ulcers?
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yes they can contribute to ulcer development and they delay healing
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