1. PEPTIC ULCER DISEASE

2. 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

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

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

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

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

7. GASTRIC CANCER

8. 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

9. 2. Smoking 3. Obesity 4. Alcohol-excess

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

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

12. ALD

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

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

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

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

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