PEPTIC ULCER DISEASE

I. Definition A. Breakdown of the mucosa of the UGI tract-non malignant 1. Lack of depth-erosion B. Imbalance between acidity (pH) and the mucosal barrier strength

II. Causes A. Helicobacter pylori B. Anti-inflammatory medications C. Idiopathic

III. Treatment A. Regardless of cause, acid lowering medications B. Treat the underlying cause

IV. Symptoms A. Epigastric pain B. Can decrease in intensity with duodenal location C. Nausea and Vomiting D. Gastrointestinal blood loss

V. Diagnosis A. Endoscopy B. Radiology C. Serologic tests for H. Pylori

GASTRIC CANCER

I. Adenocarcinoma A. Precursors 1. Chronic Gastric Atrophy a. H. pylori- WHO b. Pernicious Anemia c. ? Chronic high salt diet d. ? Multiple other environmental factors

2. Smoking 3. Obesity 4. Alcohol-excess

B. Symptoms 1. More intense than ulcer or gastritis 2. Weight loss 3. Anorexia 4. Anemia and bleeding

C. Treatment 1. Surgery is only cure 2. CTX and XRT are only palliative

ALD

I. Diagnosis A. History 1. CAGE a. Cut down b. Annoyed c. Guilty d. Eye Opener

2. Family History 3. Frequent ED visits 4. Encounters with law enforcement 5. Difficulty with employment and relationships

B. Physical Exam & Lab 1. Non-specific C. Imaging Studies 1. Exclude other pathologies D. Role of liver biopsy

II. Treatment A. Prevention 1. Abstinence a. 5 year survival-15% B. Nutrition C. Alcohol Withdrawl D. Corticosteroids/pentoxifylline

E. Complications 1. Fluid Overload a. Paracentesis 2. Gastrointestinal Bleeding a. Life-threatening emergency 3. Hepatic Encephalopathy a. Determine the cause