Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
33 Cards in this Set
- Front
- Back
|
1. A 45 yo man has signed symptoms consistent with Peptic Ulcer Disease (PUD). She has so frantic and H2 receptor antagonists in the past with success, but the symptoms are currently unrelieved with medication. What is the next step?
|
a. Perform a diagnostic EGD
|
|
|
2. Most like the diagnosis of above scenario?
|
a. Peptic ulcer disease
|
|
|
3. Treatment options for peptic ulcer disease?
|
a. Testing for H. pylori should be performed, and if positive results are attained, treatment should be administered.
b. The H. pylori status is negative, conventional treatment for peptic ulcer disease should be administered. |
|
|
4. Reasons patients may fail optimal medical therapy for peptic ulcer disease?
|
a. Presence of H. pylori
b. High gastrin levels c. Noxious stimuli such as NSAIDs. |
|
|
5. Note: despite advances in medical therapy for the inhibition of acid secretion and the eradication of H. pylori, surgery remains important in treating patients suffering from peptic ulcer disease.
|
5. Note: despite advances in medical therapy for the inhibition of acid secretion and the eradication of H. pylori, surgery remains important in treating patients suffering from peptic ulcer disease.
|
|
|
6. Surgical treatment of choice for peptic ulcer disease?
|
a. Vagotomy procedures with or without drainage
b. Gastric resections are less frequently used. |
|
|
7. Note: there are 5 types of gastric ulcers.
|
7. Note: there are 5 types of gastric ulcers.
|
|
|
8. Most common gastric ulcer type?
|
a. Type I ulcers located on the lesser curvature at or proximal to the incisura.
b. They account for 60 to 70% of ulcers. |
|
|
9. Type I ulcers?
|
a. Located on the lesser curvature or the gastric body at or proximal to the incisura.
|
|
|
10. Acid secretion associated with type I ulcers?
|
a. Low
|
|
|
11. Type II ulcers?
|
11. Type II ulcers?
|
|
|
12. Acid secretion associated with type II ulcers?
|
a. High
|
|
|
13. Type III ulcers?
|
a. Prepyloric region
b. Type III gastric ulcers are located within 2 cm pylorus (ie, prepyloric) and are also associated with excess acids secretion. c. Again hemorrhage and perforation are frequent with this type of gastric ulcer. |
|
|
14. Acid secretion associated with type III ulcers?
|
a. High
|
|
|
15. Type IV ulcers?
|
a. High on lesser curvature
b. Type IV gastric ulcers are rarely encountered and are situated within 2 cm of the gastroesophageal junction c. They are associated with hypochlorhydria, and carry a significant operative mortality risk. d. Hemorrhage is uncommon in this type of ulcer, although penetration is frequent. |
|
|
16. Acid secretion associated with type IV ulcers?
|
a. Low.
|
|
|
17. Type V ulcers?
|
a. Located anywhere in the stomach and are a direct result of chronic ingestion of aspirin or NSAIDs.
|
|
|
18. Acid secretion associated with type V ulcers?
|
a. NSAIDs
|
|
|
19. Role of H. pylori in gastric ulcers?
|
a. The aetiological role is not a strong as in the case of duodenal ulcers.
|
|
|
20. What are the most common contributing mechanisms to duodenal peptic ulcer disease?
|
a. Acid and pepsin secretion in conjunction with H. pylori infection or the ingestion of NSAIDs.
b. Gastric acids rates are usually increased in patients with duodenal ulcer disease. c. There is strong evidence for association between gastric antral infestation with H. pylori and duodenal ulcer disease, particularly with ulcers that are resistant to or recur after standard anti-secretory therapy. d. Moreover, in patients infected with H. pylori, complete eradication of the organism results in extraordinarily high healing rates and lower recurrence rates of approximately 2%. |
|
|
21. Should you test for H. pylori with gastric ulcers?
|
a. Yes, because it is found in 60-90% of gastric ulcers, and those who are not infected tend to be NSAID users.
|
|
|
22. What per cent of pts w/duodenal ulcers have H. pylori?
|
a. >90%.
|
|
|
23. Noninvasive testing for H. Pylori?
|
a. Serologic
b. Urea breath test |
|
|
24. Useful invasive testing for H. pylori?
|
a. Rapid urease assay or a histologic
b. Histologic study and cultures in conjunction w/endoscopy. |
|
|
25. For an initial study for H. pylori w/out endoscopy what is the test of choice?
|
a. Serologic study.
|
|
|
26. Tests w/endoscopy for H. pylori?
|
i. Rapid urease
ii. Histologic examination b. Both are excellent options, although the rapid urease is less expensive. |
|
|
27. PUD relapse rate in people w/H. pylori treated vs. untreated?
|
a. Untreated relapse rate: 58%
b. Treated relapse rate: 2%. |
|
|
28. Acronyms for each of the 3 Triple therapies for H. pylori?
|
1. OAC
2. OMC 3. OAM |
|
|
29. OAC?
|
a. Omeprazole (or other PPI)
b. Amoxacillin c. Clarithromycin |
|
|
30. OMC?
|
a. Omeprazole
b. Metronidazole c. Clarithromycin |
|
|
31. OAM?
|
a. Omeprazole
b. Amoxacillin c. Metronidazole |
|
|
32. Regimen length of OAC, OMC, OAM?
|
a. 1-2 weeks
b. They do not contain bismuth and are taken twice daily. |
|
|
33. For how long should a gastric ulcer be treated?
|
a. 8-12 weeks and then evaluated for healing.
b. If healing has not occurred, a biopsy should be repeated to r/o malignancy. |
