1
MS2 GI AND BILIARY SYSTEM OVERVIEW AND KEY CONCEPTS
SPECIFIC TO REAL EXAM-2026 LATEST VERSION
PEPTIC ULCER DISEASE
Antacids - reduce acid concentration (aluminum hydroxide)
PPI - blocks release of acid into the stomach (omeprazole,
lansoprazole) Cytoprotective drugs - protect ulcer surface against acid
(sucralfate, misoprostol) H2 antagonists - reduce secretion of acid
(ranitidine, cimetidine)
● Antacid: do not take other drugs with this. Administer 2-3 hrs after meals
● Cytoprotective drugs: take this one hour before meals so that the
medication can protect the ulcer before food is taken
● take h2 antagonists at night (if OD) and morning and at bedtime (if BID)
● aluminum hydroxide side effect: constipation
● magnesium hydroxide side effect: diarrhea
● Propantheline - take before meals to decrease Gi secretions
Parietal Cells - release
Hydrochloric acid Chief Cells -
release Pepsinogen
G cells - release Gastrin
Pepsinogen + Gastrin = Pepsin
Pepsin + Hydrochloric acid - Acids in the stomach that are key players in the ulceration
Endoscopy - confirmatory test
- If pt develops fever after this procedure, it may indicate PERFORATION
- SIgns of perforation: rigid-boardlike abdomen, fever, hematemesis, pain
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,2
Most at risk: pt taking NSAID,
aspirin Urea breath test - to detect
H. pylori
Endoscopy - to confirm PUD
GASTRIC DUODENAL
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Ang ulcer naas tiyan Ang ulcer naas small intestine
Pain after meals Pain 2-3 hours after meals
Pain worsens with meals Pain is relieved by meals
Pain awakens pt at night
Anorexia (bc musakit kada kaon Weight gain (bc mawa ang sakit
so kung
mustop nag kaon ang pt) mukaon)
Less vomiting
Vomiting after meals
● Think about the location sa ulcer. Ang gastric naa mismo sa tiyan, whereas
ang duodenal is naa sa duodenum (first part sa small intestine). So imagine
as the food comes down, shempre mag una sa tiyan kung asa nakalocate
ang gastric ulcer, therefore, pain is felt almost immediately after meals jud
. Then sa duodenal ulcer, the food still needs to be digested sa tiyan so
pain is felt a couple of hours pa when the food comes down na to the
duodenum.
● If pt experiences nausea and dizziness, it could be a sign of
Downloaded by Fridah Rex ()
, 4
HEMORRHAGE, so report to the physician
Downloaded by Fridah Rex ()
MS2 GI AND BILIARY SYSTEM OVERVIEW AND KEY CONCEPTS
SPECIFIC TO REAL EXAM-2026 LATEST VERSION
PEPTIC ULCER DISEASE
Antacids - reduce acid concentration (aluminum hydroxide)
PPI - blocks release of acid into the stomach (omeprazole,
lansoprazole) Cytoprotective drugs - protect ulcer surface against acid
(sucralfate, misoprostol) H2 antagonists - reduce secretion of acid
(ranitidine, cimetidine)
● Antacid: do not take other drugs with this. Administer 2-3 hrs after meals
● Cytoprotective drugs: take this one hour before meals so that the
medication can protect the ulcer before food is taken
● take h2 antagonists at night (if OD) and morning and at bedtime (if BID)
● aluminum hydroxide side effect: constipation
● magnesium hydroxide side effect: diarrhea
● Propantheline - take before meals to decrease Gi secretions
Parietal Cells - release
Hydrochloric acid Chief Cells -
release Pepsinogen
G cells - release Gastrin
Pepsinogen + Gastrin = Pepsin
Pepsin + Hydrochloric acid - Acids in the stomach that are key players in the ulceration
Endoscopy - confirmatory test
- If pt develops fever after this procedure, it may indicate PERFORATION
- SIgns of perforation: rigid-boardlike abdomen, fever, hematemesis, pain
Downloaded by Fridah Rex ()
,2
Most at risk: pt taking NSAID,
aspirin Urea breath test - to detect
H. pylori
Endoscopy - to confirm PUD
GASTRIC DUODENAL
Downloaded by Fridah Rex ()
,3
Ang ulcer naas tiyan Ang ulcer naas small intestine
Pain after meals Pain 2-3 hours after meals
Pain worsens with meals Pain is relieved by meals
Pain awakens pt at night
Anorexia (bc musakit kada kaon Weight gain (bc mawa ang sakit
so kung
mustop nag kaon ang pt) mukaon)
Less vomiting
Vomiting after meals
● Think about the location sa ulcer. Ang gastric naa mismo sa tiyan, whereas
ang duodenal is naa sa duodenum (first part sa small intestine). So imagine
as the food comes down, shempre mag una sa tiyan kung asa nakalocate
ang gastric ulcer, therefore, pain is felt almost immediately after meals jud
. Then sa duodenal ulcer, the food still needs to be digested sa tiyan so
pain is felt a couple of hours pa when the food comes down na to the
duodenum.
● If pt experiences nausea and dizziness, it could be a sign of
Downloaded by Fridah Rex ()
, 4
HEMORRHAGE, so report to the physician
Downloaded by Fridah Rex ()
