Chapter 36

Question 1

PEPTIC ULCER DISEASE
-What can this be a complication of?

Answer 1

Chronic gastritis

Question 2

PEPTIC ULCER DISEASE
-What kind of disorder is this?
-What is it caused by?

Answer 2

-Upper GI tract disorder
-The action of pepsin & hydrochloric acid

Question 3

PEPTIC ULCER DISEASE
-What is this characterized by?

Answer 3

Injury to the mucosa of the esophagus, stomach, or duodenum

Question 4

PEPTIC ULCER DISEASE
-It ranges from….

Answer 4

Slight mucosal irritation/injury to sever ulceration

Question 5

PEPTIC ULCER DISEASE
-What is the MAJOR precipitant/cause?
-What can it also be caused by?

Answer 5

-H. pylori
-NSAIDs

Question 6

PEPTIC ULCER DISEASE
-What are the two types of ulcers that can occur with this?

Answer 6

1. Gastric Ulcers
2. Duodenal Ulcers

Question 7

PEPTIC ULCER DISEASE: Gastric Ulcers
-What is this caused by?
-What does it cause?

Answer 7

-breakdown of the protective mucous layer
-Chronic irritations

Question 8

PEPTIC ULCER DISEASE: Gastric Ulcers
-What does the protective mucous layer normally do?

Answer 8

Prevents the diffusion of acids into gastric epithelia

Question 9

PEPTIC ULCER DISEASE: Gastric Ulcers
-What can cause this?

Answer 9

Aspirin, NSAIDs, alcohol, & bile acids

Question 10

PEPTIC ULCER DISEASE: Duodenal Ulcers
-What is this caused by?

Answer 10

-Excess secretion of acid that is mediated by increased basal activity of vagus nerve

Question 11

PEPTIC ULCER DISEASE: Duodenal Ulcers
-The vagus nerve stimulates the ____ ____ cells to release?
-Why?
-What does this result in?

Answer 11

-Pyloric antrum; Gastrin
-To act on gastric parietal cells to release HCl
-High levels of HCl

Question 12

PEPTIC ULCER DISEASE: Clinical Manifestations
-What is the most common manifestation?

Answer 12

Epigastric burning pain

Question 13

PEPTIC ULCER DISEASE: Clinical Manifestations
-What is it relieved by?

Answer 13

1. Intake of food (especially dairy products)
2. Antacids

Question 14

PEPTIC ULCER DISEASE: Clinical Manifestations
-Pain of gastric ulcers typically occurs…

Answer 14

on an empty stomach BUT may present soon after a meal

Question 15

PEPTIC ULCER DISEASE: Clinical Manifestations
-Pain of duodenal ulcers classically occurs…
-What is it relieved by?

Answer 15

-2-3 hours AFTER a meal
-further food ingestion

Question 16

PEPTIC ULCER DISEASE: Clinical Manifestations
-What is a life-threatening complication that can occur?
-How does it occur?

Answer 16

-GI bleeding
-With no warning

Question 17

PEPTIC ULCER DISEASE: Diagnosis
-How is this diagnosed?

Answer 17

Upper GI barium contrast OR by endoscopy

Question 18

PEPTIC ULCER DISEASE: Diagnosis
-Gastric ulcers should be…

Answer 18

Visualized with endoscopy & biopsied to rule out malignancy

Question 19

PEPTIC ULCER DISEASE: Diagnosis
-Testing for H. pylori is recommended for what?
-What is it cotroversial for?

Answer 19

-Gastric ulcers
-duodenal ulcers

Question 20

PEPTIC ULCER DISEASE: Treatment
-What is one of the most important things to focus on?

Answer 20

Healing of the injured mucosa by reducing gastric acidity

Question 21

PEPTIC ULCER DISEASE: Treatment
-What do we want to prevent?

Answer 21

Recurrence

Question 22

PEPTIC ULCER DISEASE: Treatment
-What medications can be given for this? (4)

Answer 22

1. H. pylori antibiotics
2. H2 antagonists
3. Proton pump inhibitors
4. Sucralfate

Question 23

PEPTIC ULCER DISEASE: Treatment
-What does sucralfate do?

Answer 23

Forms a protective coating over injured mucosa

Question 24

PEPTIC ULCER DISEASE: Treatment
-What does be avoided?

Answer 24

1. Smoking (smoking cessation)
2. ASA & NSAIDs
3. Irritating foods that exacerbate symptoms (caffeinated beverages & alcohol)

Question 25

**PEPTIC ULCER DISEASE**: *Treatment* -What should be reduced?

Answer 25

Stress

Question 26

**PEPTIC ULCER DISEASE** -What are possible complications of PUD?

Answer 26

Perforation & bleeding

Question 27

**CROHN DISEASE** -What is this also called?

Answer 27

Enteritis OR granulomatous colitis

Question 28

**CROHN DISEASE** -What is this?

Answer 28

Inflammation of the GI tract that extends through ALL layers of the intestinal wall

Question 29

**CROHN DISEASE** -What does this **MOST** commonly affect? -What is **LESS** often affected? -It **MAY** affect what?

Answer 29

-the proximal portion of the colon (right side) -the terminal ileum - multiple portions of the colon

Question 30

**CROHN DISEASE** -What are suggestive findings?

Answer 30

Ulcers, strictures, fibrosis, & fistulas

Question 31

**CROHN DISEASE**: *Clinical Manifestations* -What is the MOST common manifestation?

Answer 31

Chronic abdominal pain & diarrhea

Question 32

**CROHN DISEASE**: *Clinical Manifestations* -Along with chronic abdominal pain & diarrhea, what are three other things that can happen?

Answer 32

1. Chronic RLQ pain --> may have RLQ mass 2. Blood in stool 3. Fever & fatigue

Question 33

**CROHN DISEASE**: *Complications* -What are 3 possible complications of Crohn Disease?

Answer 33

1. Perianal fissures 2. Fistulas 3. Abscesses

Question 34

**CROHN DISEASE**: *Treatment* -Is there a cure?

Answer 34

No

Question 35

**CROHN DISEASE**: *Treatment* -The best thing to do is what?

Answer 35

Alleviate/reduce inflammation

Question 36

**CROHN DISEASE**: *Treatment* -What should be stopped?

Answer 36

Smoking (smoking cessation)

Question 37

**CROHN DISEASE**: *Treatment* -What medications should be used? (5)

Answer 37

1. Drugs similar to ulcerative colitis 2. Prednisone & sulfasalazine 3. Antibiotics: metronidazole 4. Immunosupressants 5. Anti-TNF medications

Question 38

**MALABSORPTION DISORDERS AFTER SURGICAL INTERVENTION** -What are two disorders that happen after surgical intervention?

Answer 38

1. Dumping Syndrome 2. Short bowel Syndrome

Question 39

**MALABSORPTION DISORDERS AFTER SURGICAL INTERVENTION**: *Dumping Syndrome* -What is this? -Why? -When may it occur?

Answer 39

-Dumping of stomach contents into the proximal portion of the small intestine -Because of impaired gastric emptying -AFTER removal of all OR part of the **stomach**

Question 40

**MALABSORPTION DISORDERS AFTER SURGICAL INTERVENTION**: *Short Bowel Syndrome* -What is this? -When does this develop?

Answer 40

-Severe diarrhea & significant malabsorption -AFTER the surgical removal of large potions of the **small intestine**