Peptic Ulcer

Not true of peptic ulceration is

A. Common sites for peptic ulcers are the first part of the duodenum
B. H. pylori and the consumption of NSAIDs are the most important factors in the development of ulcer
C. Rapid urease test is most confirmatory of H.pylori
D. Aspirin reversibly inhibits the enzyme cyclooxygenase, whereas NSAIDs inhibit it irreversibly

All are true regarding acute peptic ulcers except

A. Acute ulcers have regular borders
B. H2-receptor antagonists are the first-line treatment for acute ulcers
C. Prostaglandin analogs (misoprostol) are sometimes used as prophylaxis for NSAID-induced injury
D. Lesions less than 5 mm in diameter are termed erosions

Most common complication of peptic ulcer disease is

A. Perforation
B. MALT lymphoma
C. Gastric outlet obstruction
D. GI bleeding

The Glasgow Blatchford score (GBS) includes all except

A. GBS is a formal risk assessment tool for upper GI hemorrhages
B. Identifies how urgently patients require endoscopic therapy
C. Patients scoring 2- 3 on the GBS can be safely discharged
D. Hemoglobin less than 10 gm is related to score component point of 6.

All of the following are associated with hypersecretory conditions of gastric mucosa except

A. Zollinger Ellison syndrome
B. Systemic mastocytosis
C. Cystic fibrosis
D. Hypoparathyroidism

All are true of progression of peptic ulcer disease except

A. Chronic duodenal ulcers are not associated with malignancy
B. Stomal ulcers after gastrectomy of the Billroth II type are usually found on the jejunal side
C. Patients with gastric ulceration are often overweight
D. Most common cause of failed healing of ulcer is persistent H. pylori infection

Which of the following procedure for peptic ulcer is associated with highest recurrence

A. Gastroenterostomy
B. Selective vagotomy and drainage
C. Truncal vagotomy and antrectomy
D. Gastrectomy

In short

  • The most popular drainage procedure along with truncal vagotomy is the Heineke–Mikulicz pyloroplasty. This operation is substantially safer than gastrectomy.
  • The most satisfactory operation for duodenal ulceration, with a low incidence of side effects and acceptable recurrence rates is highly selective vagotomy. However, the operation disappeared from routine use with the advent of antisecretory agents and eradication therapy.
  • Antrectomy and Roux-en-Y reconstruction may be the better option to avoid bile vomiting.
  • Early dumping is associated with the rise in the packed cell volume due to the sequestration of fluid from the circulation into the gastrointestinal tract. The principal treatment is dietary manipulation.
  • Late dumping is reactive hypoglycemia due to the carbohydrate load in the small bowel causing a rise in the plasma glucose, which, in turn, causes insulin levels to rise, and a secondary hypoglycaemia.

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