Peptic Ulcer Disease & Anti-Ulcer Medications , Gallbladder Problems & Pancreatitis , Tuberculosis & Medications

PUD cause (most common)

H. pylori infection is #1 cause; NSAIDs/ASA #2

PUD hallmark complication

Hemorrhage most serious complication; watch ↓H&H, coffee-ground emesis

Gastric ulcer pain

Worsens 30-60 min after eating; not relieved with food

Duodenal ulcer pain

Occurs 1.5-3 hrs after eating; relieved by eating; night awakenings

Perforation red flag

Board-like abdomen, sudden severe pain → emergency, peritonitis

Upper GI bleed sign

Bright red or coffee ground vomit indicates proximal bleed

Melena

Black, tarry stools → GI bleed beyond pylorus

H. pylori regimen rule

Requires at least 2 antibiotics + PPI/H2RA; adherence critical

H. pylori triple therapy

Clarithromycin + Amoxicillin + PPI

Quad therapy

Bismuth + Metronidazole + Tetracycline + PPI/H2RA

PPI purpose

Most effective acid suppression for ulcers & GERD

PPI cautions

Long-term → C. diff, ↓Ca/Mg, pneumonia, fractures

PPI prototype

Omeprazole (Prilosec)

H2RA prototype

Famotidine (Pepcid) for GERD/PUD

Cimetidine concern

Causes confusion in older adults; rarely used

Sucralfate action

Coats ulcer crater; protective barrier; take on empty stomach

Misoprostol use

Prevents NSAID gastric ulcers; prostaglandin analog

Misoprostol contraindication

Pregnancy (induces uterine contractions)

Dumping syndrome cause

After gastric surgery when food rapidly enters jejunum

Dumping early signs

Occur within 20 min: dizziness, tachycardia, palpitations, sweating, diarrhea

Dumping diet changes

Small frequent meals; high protein; avoid fluids with meals; avoid simple carbs

Cholecystitis hallmark

RUQ pain, radiates to right shoulder, triggered by high-fat meal

Murphy's sign

Sharp RUQ pain on inspiration with palpation → gallbladder inflammation

Cholelithiasis risk

Female, forty, fat, fertile, family history

Gallbladder labs ↑

↑bilirubin, ↑ALP, ↑ALT if obstruction

Steatorrhea

Fatty pale stools → bile duct obstruction

Pancreatitis hallmark

SEVERE LUQ pain radiating to back; worse when lying flat

Pancreatitis positioning

Knees-to-chest or side-lying leaning forward ↓ pain

Amylase/Lipase

Lipase most specific lab for pancreatitis; both elevated

Pancreatitis priority

NPO, pain mgmt, IV fluids; no morphine if sphincter spasm suspected (use hydromorphone)

Pancreatitis complications

ARDS, hypocalcemia, pseudocyst rupture, infection

Cullen sign

Bluish periumbilical discoloration → hemorrhagic pancreatitis

Grey-Turner sign

Flank bruising → retroperitoneal bleed

TB transmission

Airborne; droplet nuclei; need negative pressure room

TB test confirmation

Sputum culture is gold standard

Active TB symptoms

Weight loss, night sweats, persistent cough, fever

TB PPE requirements

N95 respirator protection

RIPE regimen

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

RIPE therapy duration

6-12 months minimum

Isoniazid risk

Hepatotoxic; monitor liver enzymes monthly

Rifampin teaching

Orange body fluids; ↓effectiveness of OCPs

Ethambutol caution

Optic neuritis; baseline eye exams

Pyrazinamide effect

Hyperuricemia → gout risk

TB isolation stop criteria

Three consecutive negative sputum cultures

DOT therapy

Directly observed therapy ensures adherence to prevent resistance