1) peptic ulcer disease is marked by a break in mucosal lining of stomach and duodenum
\n2) main causes are infection with Helicobacter pylori and use of NSAIDs<\/p>\n
1) burning epigastric pain relieved by antacids and eating
\n2) epigastric pain causing patient to wake up in the middle of the night
\n3) chest pain mimicking angina
\n4) epigastric tenderness
\n5) gastrointestinal bleeding (15%) with coffee-ground emesis or vomiting bright red blood or lower gastrointestinal bleeding
\n6) perforation (8%) with peritonitis and rigid abdomen
\n7) duodenal obstruction (3%) with nausea and vomiting<\/p>\n
Characteristic Test Findings<\/p>\n
Laboratory<\/p>\n
1) diagnosis of peptic ulcer disease is by antiurease antibodies in blood, urea breath test, rapid urease test on ulcer biopsy specimen, and presence of organinism in biopsy specimen.<\/p>\n
Radiology<\/p>\n
2) ulcer on double-contrast upper GI series<\/p>\n
Histology\/Gross Pathology<\/p>\n
1) 95% located in first part of duodenum<\/p>\n
H. plylori<\/p>\n
2) S-shaped gram-negative rod
\n3) found along the mucosa
\n4) can alkalinize surrounding environment
\n5) has a dormant coccoid state
\n6) always causes a chronic active gastritis<\/p>\n
Associated Conditions<\/p>\n
1) increased incidence of – pancreatitis (posterior penetration of ulcer), MALT tumor, gastric cancer
\n2) increased incidence with – smoking, blood group O, COPD, chronic renal failure, cirrhosis, nephrolithiasis, alpha-1-antitrypsin, glucocorticoids<\/p>\n
Biochemistiry<\/p>\n
1) H. pylori expresses virulence factors Cag A, Vac A and pic B
\n2) decreased bicarbonate secretion in duodenal bulb
\n3) increased nocturnal acid secretion
\n4) increased gastric emptying<\/p>\n
Inheritance\/Epidemiology<\/p>\n
1) H. pylori infection occurs in 20% of people < 30 years of age and 50-60% of people > 60 years of age
\n2) genetic predisposition exists<\/p>\n
Treatment<\/p>\n
H. pylori related<\/p>\n
1) two major regimens are bismuth and antibiotics (or substitute prepackaged Helidac) or omeprazole, clarithromycin, and amoxicillin or metronidazole (or substitute prepackaged Prevpac)<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Pathophysiology of Peptic Ulcer Disease 1) peptic ulcer disease is marked by a break in mucosal lining of stomach and duodenum 2) main causes are infection with Helicobacter pylori and use of NSAIDs Signs and Symptoms 1) burning epigastric pain relieved by antacids and eating 2) epigastric pain causing patient to wake up in the […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[5126],"tags":[],"yoast_head":"\n