H. pylori presents in what % of duodenal and gastric ulcers?
90 % duodenal
75% gastric
What type of ulcer is most likely in a patient between the ages of 30-55?
duodenal ulcer
What type of ulcer is most likely in a patient between the ages of 55 and 65?
gastric ulcer
What type of ulcer presents with relief of pain with eating?
duodenal
What type of ulcer presents with worsening of pain with eating?
gastric
What physical exam findings can be present with a patient who has experienced perforation?
Severe epigastric pain
“board like” abdomen
Hypoactive bowel sounds
Rigidity
and other signs of an acute abdomen
What are the potential H2 receptor antagonists used in treatment of PUD?
Cimetidine (Tagamet) 800 mg/hours of sleep
Famotidine (Pepcid) 40 mg/hours of sleep
Nizatidine (Axid) 300 mg/hours of sleep
What are the potential PPIs used in treatment of PUD?
Lanzoprazole (Prevacid) 15mg/day
Rabeprazole (Aciphex) 20mg/day
Pantoprazole (Protonix) 40mg/day
Omeprazole (Prilosec) 20mg/day
Dexlansoprazole (Dexilant) 30mg/day
Esomeprazole (Nexium) 20mg/day
H. Pylori mainstay treatments include what?
Two antibiotics + PPI w/ or w/o bismuth for 10-14 days
Patients not allergic to PCN and have not previously received a macrolide can receive what type of H. Pylori treatment?
ECA - Any standard dose PPI BID + clarithromycin 500mg BID + amoxicillin 1000mg BID x14 days
EBMT - Any standard dose PPI BID + bismuth subsalicylate 525mg QID + metronidazole 250 mg QID + tetracycline 500mg QID x 10-14 days
ECAM - Any standard dose PPI BID + clarithromycin 500mg BID + amoxicillin 1000mg BID + metronidazole 500mg BID x 10-14 days
Patients who are allergic to PCN and have NOT previously received a macrolide or are unable to tolerate bismuth quadruple therapy can receive what type of H. Pylori treatment?
ECM - Any standard PPI BID + clarithromycin 500mg BID + metronidazole 500mg TID x 10-14 days
Patients who are allergic to PCN, and who have previously recevied a macrolide can receive what type of H. Pylori treatment?
EBMT -Any standard dose PPI BID + bismuth subsalicylate 525mg QID + metronidazole 250 mg QID + tetracycline 500mg QID x 10-14 days
Antiulcer therapy is recommended following the previous regimens for 3-7 wks to ensure symptom relief and ulcer healing.
How long may a PPI be continued?
How long can H2 blockers or sucralfate be given?
7 weeks
6-8weeks
If there is concern for free air related to a perforated ulcer, what type of imaging should be ordered?
What is the sensitivity?
Upright or decubitus films show free air in 75% of cases
