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22 Cards in this Set

  • Front
  • Back
Risk Factors/Causes of PUD
H. Pylori
NSAIDs
Smoking
Booze
Increased Gastrin Release
Genetics
Blood Group (O)
H. Pylori
-gram?
Negative
H. Pylori
where it lives
on surface of mucosa, never penetrates
H. Pylori
produces?
Urease and toxins
4 Things H. Pylori can cause?
Gastritis
Peptic Ulcer
MALT lymphoma
Gastric Cancer
How does H. Pylori cause Duodenal Ulcers?
Ingestion
Colonization
Antral Gastritis
Inhibits D Cells
Decreased Somatostatin
Increased Gastrin
Increased Acid
DU
How does H. Pylori cause MALT?
Ingestion
Colonization
Releases Urease, toxins, and multiplies
Prolif of B Cells
Polyclonal
Monoclonal
Lymphoma
How does H. Pylori cause Gastric Cancer?
Ingestion
Colonization
Pan Gastritis
Acute Gastritis
Chronic Gastritis
Gastric Atrophy
CANCER
Tests for H. Pylori
2 broad categories
Endoscopic

Non-endoscopic
Non-endoscopic Tests for H. Pylori
NON-ENDOSCOPIC
Serum H. Pylori AB (not good for confirming eradication)
Urea Breath Test (better)
Stool Ag Test (not as available)
Endoscopic Tests for H. Pylori
Biopsy Urea Test (solid)
Histology
Culture (100% specific)
Typical Rx for H. Pylori induced Peptic Ulcers
TRIPLE:
PPI + Clarithromycin + Amoxicillin
PPI + Clarithromycin + Metronidazole

QUAD:
PPI + Clarithromycin + Amoxicillin + Tetracycline
When do you test for eradication?
1 month after stopping treatment
5 complications of peptic ulcers and %'s
Refractory ulcers
bleeding (15%)
penetration (5%)
perforation (7%)
obstruction (2%)
Refractory Ulcers
Patient Related Factors
NSAIDs
Booze
Smoking
Hypersecretory states
H.Pylori
Fungal infections
Refractory Ulcers
Ulcer Related Factors
Large
Penetrated
Linear
Refractory Ulcers
Drug Related Factors
Resistance
Inadequate dose
tolerance
Refractory Ulcers
Physician Related Factors
Wrong Dx
How do Peptic Ulcers present?
Hematemesis (vomit blood)
Melena (black, tarry, smelly poo)
Hematochezia (fresh blood from rectum)
Also: Chest pain, sweating, pallor, dizziness, fainting, tired, shock
Risk Factors for GI Bleeding
over 60
hematemesis w/ melena
Drugs: nsaids, warfarin, steroids
Continued bleeding
bleeding in hospital
CCF, COPD, Renal Failure, Liver Disease
List of lesions and their risk of bleeding if untreated (in order from least risk to highest)
Clean Base
Black Spot
Sentinel Clot
Visible Vessel
Arterial oozing
Arterial Spurt
Consequences of Prolonged Acid Suppression
Hypergastrinemia
Carcinoids
Bacterial Overgrowth
B12 def
Gut infection