Peptic Ulcer Disease Lecture Notes

These flashcards cover key concepts and management strategies related to Peptic Ulcer Disease, as outlined in the lecture notes.

What causes Peptic Ulcer Disease (PUD)?

• Erosion of GI mucosa from HCl acid and pepsin.

What are the susceptible areas of the GI tract for PUD?

• Lower esophagus, stomach, duodenum, and post-op gastrojejunal anastomosis.

What is the difference between acute and chronic ulcers?

• Acute ulcers are superficial with minimal inflammation (goes through the mucosa and submucosa only)

• Chronic ulcers involve erosion of the muscular wall and form fibrous tissue. (extends beyond submucosa into deeper layers, leading to complications such as perforation or bleeding.

What are the risk factors for gastric ulcers?

• Helicobacter pylori, NSAIDs, bile reflux, and increased mortality.

What is a common symptom of duodenal ulcers?

• Burning or cramplike pain in the mid-epigastric area 2 to 5 hours after meals.

What diagnostic test is considered the gold standard for diagnosing H. pylori infection?

• Biopsy of antral mucosa with testing for urease.

What are the treatment goals for Peptic Ulcer Disease?

• Decrease gastric acidity and enhance mucosal defense mechanisms.

Name one medication that is effective in reducing gastric acid secretion.

• Proton pump inhibitors (PPIs).

What is a common complication of Peptic Ulcer Disease?

• GI bleeding, perforation, and gastric outlet obstruction.

What symptoms indicate perforation in PUD?

• Sudden, severe upper abdominal pain radiating to back and shoulders, rigid abdomen, absent bowel sounds.

What dietary modifications should PUD patients make?

• Avoid foods that cause distress, caffeine, and alcohol.

What is the potential outcome of untreated perforation in PUD patients?

• Bacterial peritonitis occurs within 6-12 hours.

What is the role of lifestyle changes in managing PUD?

• To prevent recurrence and complications.

What is a Billroth II procedure?

• A surgical technique used for partial gastrectomy in cases of peptic ulcers.

What immediate care is necessary for a patient with gastric outlet obstruction?

• NG tube for suction, IV fluids, pain management, and potential surgical intervention.

What is the most common cause of increased gastric acid production and mucosal damage in the stomach is?

• H. pylori infection is the most common cause.

The main cause of duodenal ulcers is due to?

• Excess acid production by the stomach caused by H. pylori infection which then flow into the duodenum.

How is H. pylori bacteria transmitted?

• H. pylori is primarily transmitted through the oral-oral or fecal-oral route, often via contaminated food or water.

• From family members to a child.

Main contributing lifestyle factors that increase risk of peptic ulcer disease include:

• Alcohol use

• Smoking

• Coffee

• Psychologic distress and depression can delay healing of present ulcers.

The timing and location of pain can help differentiate between gastric (stomach) and duodenal ulcers when trying to recognize cues. What are the signs/symptoms of gastric vs duodenal clinical manifestations?

• Gastric = epigastric discomfort 1 to 2 hrs after a meal; burning or gaseous pain; food may worse

• Duodenal = burning or cramping pain in mid-epigastric or back 2 to 5 hrs after a meal.

Non-invasive tests for H. pylori include:

• Breath testing: excess Co2 in breath can be a sign of H. pylori infection

• Stool

• Serology

Best pharmacological treatment for H. pylori include:

• Proton pump inhibitors (omeprazole) > more effective than H2 blockers (cimetidine, famotidine)

• Used in conjunction w/ antibiotics to Tx. H. pylori.

The most reliable test to determine the presence and location of an ulcer is:

• Endoscopy