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Risk Factors, 7.01 MECHANISTIC DIAGRAM, Gerry Guo, Kara Harris, Mohammed…
Risk Factors
NSAID use (piroxicam)
Inhibits COX1
Inhibits prostaglandin production
Increased gastric acid secretion
Reduced mucous production
Reduced bicarbonate production
Replace with paracetamol
Helicobacter pylori
infection
Virulence factors
Urease
Breaks down urea into ammonia and CO2
Neutralises stomach acid near bacteria
Reduced protection against pathogens
Mucinase
Breaks down mucus
Cytokines
Inflammation of mucosal epithelium
Active chronic gastritis
PEPTIC ULCER DISEASE
Acute upper GI bleed
Melaena
'Coffee ground' vomit
Hypovolaemia
Pre-renal AKI
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Compensatory tachycardia
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Popstural hypotension
Lethargy
Breakdown of RBC and absorption
Elevated urea (11.8 mmol/L) and urea/creatinine ratio
Low Hb (70 g/L) and normal MCV
Treat acutely endoscopically with adrenaline and heat probe
Epigastric burning pain
Not relieved by eating or antacid
Nausea
Dyspepsia
Endoscopy - 2cm gastric ulcer in pre-pyloric region of greater curvature
Erosion into L/R gastroepiploic arteries
Biopsy to confirm H. pylori cause and to exclude gastric adenocarcinoma
Repeat endoscopy in 6 weeks to ensure healing
Neutrophil and mononuclear cell infitration
Phospholipase
Breaks down phospholipids in epithelium
Paternal history of stomach ulcers
Triple therapy: amoxicillin + clarithromycin + PPI
PPI irreversibly binds the apical K+/H+ ATPase
Patient is 79 and complains of lower back pain - hence avoid long term PPI
Amoxicillin inhibits peptidoglycan wall synthesis
Clarithromycin via inhibiting protein synthesis through binding to 50s ribosomal subunit
Bismuth compounds
79 years old
Smoking
Smoking cessation
7.01 MECHANISTIC DIAGRAM
Gerry Guo, Kara Harris, Mohammed Hassan, Christy Hou & Daniel Kasunic