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33 Cards in this Set
- Front
- Back
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inflammation or erosion of the gastric lining is called |
gastropathy or gastritis |
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causes of gastritis |
alcohol NSAIDs H pylori portal htn stress |
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what types of stress espeically predispose to gastritis? |
burns trauma sepsis multiple organ failure |
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atrophic gastritis is associated with... |
B12 deficiency, pernicious anemia basically |
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the most common clinical presentation for gastritis |
bleeding without pain |
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the most common reasons that they will list are... |
NSAIDs and alcohol |
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What degree of bleeding is usually present with gastritis? |
can be just about any degree of bleeding in presentation |
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the classic sign of bleeding would be |
coffee ground emesis which can indicate gastritis OR peptic ulcer disease also |
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but another obvious sign of gastric bleeding could be |
melena, heme positive stools |
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he basically says test for H pylori |
in all patients with gastritis |
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what is the tx for gastritis |
PPIs |
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4 testing options for H pylori |
endoscopic biopsies serologies urea breath testing stool antigen |
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the main advantage of endoscopic biopsy for H pylori |
most accurate
but it's also the most invasive |
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the advantage of serology for H pylori is |
it's cheap and easy, definitiely excludes exposure if it's negative so it's the best option with low pretest probability |
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the limitation of serology is that |
it lacks specificity
doesn't tell you if it's a current exposure or past exposure and so on |
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what is sucralfate? |
just an inert substance used to coat the stomach or ulcer base |
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How can you distinguish between a gastric and duodenal ulcer |
the only way to do so definitively is through EGD!
but there are hx clues in relation to meals as well |
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most common cause of PUD |
H pylori infection |
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2nd most common cause of PUD is |
NSAID use |
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other more rare causes
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burns (Curling ulcer) head trauma (Cushing ulcer) Crohn's gastric cancers gastrinomas (ZES in MEN syndromes and so on)
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do alcohol and smoking cause ulcers? |
no they just delay healing of an ulcer |
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how do patients describe the pain of an ulcer? |
dull, sore, gnawing
related to meals |
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Do most ulcers bleed. |
no most do NOT bleed |
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is epigastric tenderness a common finding with PUD? |
no it's a rare finding actually |
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Why is EGD said to be the best test for PUD? |
because you can get biopsies for H pylori testing, the most accurate way to dx H pylori
AND EGD is the only way to dx gastric cancers so it's a good screen for malignancy as well |
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What type of ulcer does H pylori cause more often: duodenal or gastric? |
80 to 90% of duodenal ulcers are caused by HP
it still causes between 50 and 70% of gastric ulcers too though |
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Do most cases of PUD respond to PPIs? |
yes they do, but ulcers will recur if H pylori is not eradicated |
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the best initial therapy for eradicating H pylori is |
triple therapy: clarithromycin + amox + PPI |
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If a patient doesn't respond to triple therapy... |
then add metronidazole or doxycycline to amox/clarithromycin |
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What drug has shown some benefit in helping ulcers resolve as well? |
bismuth |
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How do you confirm eradication of H pylori? |
repeat breath test or stool antigen to make sure it's gone |
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if initial therapy for a DU does not show a good response you should... |
do a repeat breath test or stool antigen here also to confirm persistent HP infection
then you should switch to metronidazole or doxy |
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do you routinely biopsy a duodenal ulcer? |
no DU's are rarely biopsied
GU's are almost always biopsied though |
