NSG 533 Ch 18 - Peptic Ulcer Disease Questions with DETAILED complete solution 2023/2024

NSG 533 Ch 18 - Peptic Ulcer Disease Questions with DETAILED complete solution 2023/2024 Ulcers caused by H. Pylori - Risk Factors & Pathogenesis - correct answer Risk Factors: 1. H. Pylori is usually contracted within the first few years of life and tends to persist indefinitely unless treated. Normally resides in the stomach and is transmitted through ingestion of fecal-contaminated water or food. The organism causes gastritis in all infected individuals, but fewer than 10% actually develop symptomatic PUD. Pathogenesis: 1. Ulcers related to H. Pylori infection more commonly occur in the duodenum (duodenal ulcers). May cause gastroduodenal mucosal injury through: a. direct mucosal damage, b. alterations in host inflammatory response c. hyper-gastrinemia and elevated acid secretion Ulcers caused by H. Pylori - S&S, Clinical Course & Prognosis - correct answer S&S: Uncomplicated vs complicated 1. UNCOMPLICATED - mild epigastric pain 2. COMPLICATED - GI complications such as bleeding (melena, hematemesis, or occult), obstruction, or perforation. Early satiety, N/V, abdominal pain, and weight loss. Clinical course: 1. Those younger than 60 should be non invasively tested for H. Pylori and treated if positive. a. Invasive testing: endoscopy and biopsy. b. Noninvasive: urea breath test, serologic testing, and stool antigen assay. The urea breath test is usually first-line due to high sensitivity and specificity and short turn around time. It can also confirm eradication. *Important Note: Concomitant acid-suppressive or antibiotic therapy may give false results. Serologic testing recommended in these patients as it cannot differentiate between active and non-active infection. *Important Note 2: Use of antimicrobial agents within 4 weeks, PPI's within 2 weeks, and H2RA's within 24 hours of testing can suppress the infection and reduce sensitivity. Treatment: 1. The goal of H. Pylori therapy is to eradicate the organism using an effective antibiotic-containing regimen. *Important Note: Reliance on conventional acid-suppressive drug therapy alone as an alternative to H.Pylori eradication is inappropriate because it is associated with a higher incidence of ulcer recurrence and ulcer-related complications. *Important Note 2: Several regimens are recommended as first-line eradication therapy. Different antibiotics should be used if the second course of H. pylori eradication therapy is required. *Important Note 3: Cure rates of H. pylori with H2RA's in combination with antibiotics are lower than with PPI's *Important Note 4: Antibiotics to eradicate H. pylori -(See table 18-2) 2 . Strong recommendations based on current guidelines: a. Bismuth quadruple therapy - Bismuth sub salicylate 300 mg QID, metronidazole 250-500 mcg QID + tetracycline 500 mg QID + PPI BID. OR Concomitant therapy - Clarithromycin 500 mg BID + Amoxicillin 1 g BID + nitroimidazole 500 mg BID + PPI BID. Both courses 10-14 days. b. Salvage regimen only - Rifabutin triple therapy - Rifabutin 300 mg daily + amoxicillin 1 g (BID or TID) and PPI BID for 10 days.