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Peptic Ulcer disease (PUD (s/s: Asx (20%) (Symptomatic s/s: "…

- - - - Ulcer appearance:
        
        Shallow & multiple (NSAID)
        
        large heaped margins & necr. centers (malignancy)
        
        single ulcer (may be H Pylori)
        
        refractory, multiple, w/ diarrhea (Gastrinoma)
      - History correlates:
        
        Burns (Curling)
        
        Cushing (hi ICP, steroids ventilators) :warning: use PPI, feed w/ NG tube trickle feed
  - - - :pencil2:take w/ a grain of salt, this is not accurate in real life. Do not rely on history alone, but shelf logic is ok
- - - - :check: w/ relevant Hx
        
        :checkered_flag: NSAID use
        
        Tx: :no_entry:Stop NSAID give PPI BID
        
        prophy PPI daily
        
        :pencil2: Ok to still get biopsy to confirm
      - :green_cross: Nothing w/ no relevant Hx
        
        Biopsy
        
        Malignancy
        
        Tx: Stage & treat (outside lecture scope)
        
        H Pylori
        
        Tx: Triple Therapy :helicopter:
        
        :red_cross: negative biopsy
        
        :checkered_flag: Regular Ulcer
        
        Tx: PPI
- - - - Cost effective: Test & Treat method
        :pencil2: good if pt never been treated, hasn't been H Pylori + before
      - Urea Breath teat
        
        Good for initial diagnosis
        :pencil2: Useless if on PPI
- - - - :green_cross:normal < 250
      - :check: hi > 1600
      - :shrug::skin-tone-2: indeterminate 250-1600
        
        Secretin Stim test
        
        :check: raise in Gastrin levels
        
        :checkered_flag: Go find the gastrinoma
        
        :check: best choice :stars: SRS: imaging for somatostatin Rc
        
        :warning:CT scan : not as good
        
        Tx: Resection
        
        f/u: Malignancy may occur if not treated