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Ercjdv A lower level may be normal if the blood was drawn around the end of a pulse. how does plaquenil work TAbLE Helicobacter pylori Eradication Regimen Advantage Disadvantage triple therapy PPI plus two antibiotics Twice daily dosing More expensive than bismuthbased triple therapy Quick Hit Acid suppression therapy H blockers Ranitidine Famotidine Nizatidine Cimetidine PPIs Esomeprazole Omeprazole Lansoprazole Pantoprazole Rabeprazole Quadruple therapy PPI bismuth subsalicylate and two antibiotics Half the time as triple therapy a week program as opposed to weeks for triple therapy yet reaps similar eradication results Expense of PPI Diseases of the Gastrointestinal System l StePUP to meDiCine TAbLE Complications of Peptic Ulcer Disease clinical Findings Diagnostic Studies Management Other Perforation Acute severe abdominal pain signs of peritonitis hemodynamic instability Upright CXR free air under dia phragm CT scan is the most sensitive test for perforation detects free abdominal air Emergency surgery to close per foration and perform definitive ulcer operation such as highly selective vagotomy or truncal can progress to sepsis and death if untreated vagotomypyloroplasty Gastric outlet obstruction Nauseavomiting poorly digested food epigas tric fullnessearly sati ety weight loss Barium swallow and upper endos copy saline load test empty stomach with a nasogastric tube add mL saline aspirate after Initially nasogastric suction replace electrolytevolume deficits supplement nutrition if obstruction is longstanding Most common with duodenal ulcers and type III gastric ulcers mintest is positive if aspi rate mL Surgery is eventually necessary in of patients Gi bleeding Bleeding may be slow leading to anemic symp toms or can be rapid and severe leading to shock Stool guaiac upper GI endoscopy diagnostic and therapeutic Resuscitation diagnose site of bleed via endoscopy and treat perform surgery for acute bleeds that require transfusion of units of blood Peptic ulcer dis ease is the most common cause of upper Gi bleeding If the patient has an active NSAIDinduced ulcer stop NSAID use may switch to acetaminophen. Gvprpx

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