Peptic Ulcer Disease

Chapter 32 Peptic Ulcer Disease




Clinical Case Problem 1: A 58-Year-Old Man with Epigastric Pain


A 58-year-old man with a 4-month history of epigastric pain presents to your office. The pain is described as dull and achy and is intermittent. There is no radiation of the pain. Exacerbating factors include coffee intake. Infrequently, he is awakened at night from the pain. Temporary alleviating factors include eating a meal or taking nonprescription H2 antagonists. The baseline intensity of the pain is approximately 6 out of 10, but it can fluctuate in intensity to an 8 out of 10. The pain has not changed since it began 4   months ago. No weight loss, vomiting, melena, or hematochezia has been noted, but nausea does occur at times. The patient denies any dramatic increase in his usually stressful career, and he describes his position as a “high-powered executive.” He admits that he is a “workaholic.” He has no prior history of chronic abdominal pain, and he takes no regular prescription medications or nonprescription analgesics.


On examination, the patient has some epigastric tenderness with no rebound or guarding. The remainder of the examination is unremarkable.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. gastric carcinoma

b. gastric ulcer

c. duodenal ulcer

d. cholecystitis or cholelithiasis

e. irritable bowel syndrome

2. Which of the following statements regarding the patient described is false?


a. upper endoscopy with biopsy for Helicobacter pylori is indicated

b. cigarette smoking may aggravate the condition

c. drinking alcohol aggravates the condition

d. this patient should be treated with a bland diet

e. this condition may be aggravated or caused by the ingestion of certain medications

3. Which of the following is most sensitive and specific for detection of Helicobacter infections?


a. serology for IgG against H. pylori

b. urea breath test

c. H. pylori stool antigen

d. endoscopic biopsy with histologic examination

e. none of the above is particularly sensitive

4. The patient is found to be H. pylori positive and prescribed a combination of lansoprazole, clarithromycin, and amoxicillin for 14   days for his condition. His symptoms improve rapidly, and he is essentially pain free in 2   weeks. Which of the following statements is true about this treatment?


a. amoxicillin was prescribed because of a high probability of sepsis in his condition

b. a combination of omeprazole, clarithromycin, and amoxicillin for 14   days would probably be equally effective

c. a combination of bismuth, metronidazole, and an H2 blocker for 14   days would probably be equally effective

d. a combination of clarithromycin, amoxicillin, and lansoprazole for 7   days would be less effective

e. none of the above

5. What is the mode of action of omeprazole?


a. an H1 receptor antagonist

b. an H2 receptor antagonist

c. a proton pump inhibitor (PPI)

d. a cytoprotective agent

e. an anticholinergic agent

6. The condition described should respond to treatment with complete healing within a maximum of how many weeks?


a. 1 or 2 weeks

b. 3 to 6 weeks

c. 8 to 12 weeks

d. 16 to 20 weeks

e. 26 to 52 weeks

7. Which of the following drugs is classified as a cytoprotective agent?


a. metoclopramide

b. misoprostol

c. bismuth subsalicylate

d. ondansetron

e. nizatidine

8. Which of the following statements regarding the role of drugs in the condition described is false?


a. cyclooxygenase type 2 (COX-2) inhibitors do not cause this condition

b. the use of dexamethasone is a risk factor for this condition

c. aspirin may precipitate this condition

d. some nonsteroidal antiinflammatory drugs (NSAIDs) seem more likely than others to precipitate this condition

e. the incidence of this condition in patients taking indomethacin or other NSAIDs is increased

9. Which of the following statements regarding H. pylori is true?


a. chronic infection is uncommon in most areas of the world

b. organisms are found in human feces but not saliva

c. income and socioeconomic factors do not influence prevalence

d. approximately 10% of adults with dyspepsia recolonized

e. prevalence of infection is higher in Hispanics and African Americans

10. Which of the following statements regarding the diagnosis and treatment of gastric ulcers is false?


a. the pain of gastric ulcers, in contrast with duodenal ulcers, is sometimes aggravated rather than relieved by food

b. gastric ulcers do not present with bleeding or perforation as the initial presentation

c. endoscopy should follow the identification of a gastric ulcer on a gastrointestinal (GI) series

d. the healing rate and the time to heal for gastric ulcers are generally longer than those for duodenal ulcers

e. anorexia, nausea, and vomiting are more common in patients with gastric ulcer than duodenal ulcer

11. Advantages of PPIs over H2 blockers include all of the following except


a. superior acid suppression

b. faster healing rates

c. safe for use in hepatically impaired patients

d. faster symptom relief

e. lower and less frequent dosing requirement

12. Endoscopy is indicated for all of the following except


a. a 57-year-old man with new dyspepsia and weight loss

b. a 35-year-old woman with epigastric pain that is worse with eating and associated with anorexia and early satiety

Related posts:

  1. Alcohol
  2. Colorectal Cancer and Other Colonic Disorders
  3. Sexual Dysfunction
  4. Illustrated Review

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Peptic Ulcer Disease

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