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27 Cards in this Set
- Front
- Back
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where does the ulcer usually form?
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wall of GI tract in duodenum or stomach
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what are three common peptic ulcers?
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Helicobacter pylori - associated - chronic
NSAID - induced (chronic) Stress ulcers/SRMD (acute) |
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HP infection usually occurs where?
NSAIDs ulcer usually occurs where? |
HP - duodenal ulcers
NSAIDs - stomach |
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Helicobacter pylori transmission is?
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fecal-oral transmission
more common in developing countries colonization does not mean active infection -need cellular invasion to cause infection |
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What percentage of regular NSAID users get ulcers?
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15-30%
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What are some risk factors for NSAID-induced upper GI complications?
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age > 60
history of PUD history of upper GI bleed concomitant corticosteroid therapy Duration of NSAID use high dose NSAID use Nsaid related dyspepsia anticoagulant or coagulopathy CVD & other comorbid conditions |
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What are other factors attributed to NSAID induced PUD?
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Cigargettes
-may impair healing of ulcers Stress Diet -coffee, tea, cola, beer, spicy food |
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What is the pathophysiology attributing to ulcer formation?
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Lack of balance between factors that break down food (gastric acid and pepsin)
Factors that promote epithelial helaing (bicarbonate, mucus secretion, and prostaglandins) |
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Gastric acid and pepsin secreation is normal or slightly eleveated in PUD, T/F?
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T
NSAIDs do not effect acid secretion HP infection causes slight increase in acid secretion |
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What does pepsin do?
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initiates protein digestion and proteolysis of collagen
proteolytic activity may cause ulcer formation |
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How does mucosal defense work?
what effect do prostaglandins have on the GI environment? |
mucosal gel
buffering action allows acidic environment in lumen but near neutral pH on epithelial lining Prostaglandins inhibit gastric secretion stimulate mcus and phospholipid production promote bicarbonate secretion increase mucosal cell turnover |
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Helicobactor pylor is gram-negative microaerophilic rod?
How does HP cause direc mucosal injury? |
yes, it is also S shaped with flagella
causes gastroduodenal injury through: direct mucosal damage alterations to host inflammatory response hypergastrinemia causing increased acid secretion |
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How do NSAIDs work and cause GI damage?
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inhibit both COX-1 and COX-2 inhibition causes irritation
also is weakly acidic so it is a topical irritant systemic pharmacologic action is promary cause of PUD |
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Why is it bad to inhibit COX-1?
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becasue COX-1 leads to the production of PGs that are GI protective
produces productive prostaglandins that regulate GI mucosal integrity, renal fx, platelet homeostasis |
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Why are COX-2 good to inhibit?
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theres cyclooxygenases lead to inflammation
these PGs are related to pain, fever, and inflammation |
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What are some complications of PUD?
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- bleeding - erosion of ulcer into artery
- obstruction - scarring or inflammation near peripyloric region leading to gastric retention and early Satiety |
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What are some symptoms of PUD?
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epigastric pain, abdominal pain, nocturnal pain, pain severity fluctuates, pain often 1-3 hrs after meals, heartburn, belching, bloating, N/V
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Signs of PUD?
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weight loss - associated with N/V
complications - bleeding, perforation, obstruction alarm signs = bleeding, anemia, tarry stools, coffee ground emesis, weight loss |
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What are some desired out comes of treatment?
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resolve symptoms
decrease acid secretion promote epithelial healing prevent ulcer related complications prevent ulcer recurrence if HP, then eradicate |
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What are some lifestyle modifications for PUD?
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What are some HP eradication regimens?
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Prevent NSAID-Induced Ulcer
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