okay so here's our friend
h pylori it's a gram negative
bacillus now you guys have been with us
for the antibiotic videos and if you
haven't seen them you'll want to check
those out
but we all know that gram negative is
harder to treat
bacillus just means the shape of the bug
and we'll see that
on our reports when you're looking at
those now the h
pylori hides in between mucous and
epithelial cells
so here's the deal here's why you can
survive
longer living in there because it's in
between the mucous and the epithelial
so that's why the gastric acid doesn't
kill
h pylori because unsadly it's
protected by that layer of mucus and the
bicarbonate okay
so keep in mind why do h pylori
survive gastric acid because my own body
protects him
with the mucus and the prostaglandin is
in the bicarbonate
this is actually the most common cause
of peptic ulcer disease
i know you may have been taught that or
in your life people may have told you
oh stress is what does it but really
h pylori is really the most common cause
of peptic ulcer disease
so we've talked about h pylori that
nasty bug that
hides in between our mucous and gets
protected from gastric acid
now let's talk again about nsaids we
briefly discuss those but they inhibit
prostaglandins
so now that it's been a minute since we
talked about nsaids
can you remember what is the end result
of less
prostaglandin pause the video take a
minute
and write yourself the answer to that
question in the margin of your notes
why is the inhibition of prostaglandins
a cause of peptic ulcer disease
remember prostaglandins are what help
keep
us healthy levels of mucous and
bicarbonate and if you take a drug
like nsaids non-steroidal
anti-inflammatory drugs
that inhibit prostaglandins that means
we'll have less of them available
you have less healthy levels of mucous
that has bicarbonate
that will neutralize gastric acid that's
why people who have to take
lots of nsaids people usually with joint
pain and arthritis are taking
high doses of these medications for
their anti-inflammatory effects
they're taking high doses of these
medications over long periods of time
and sometimes we even need to take some
real steps to help protect that stomach
lining for them
now we've talked about gastric acid a
healthy stomach lining
protects that very sensitive stomach
lining remember that cupcake
if you're in too much of a hurry and you
try and frost it too quickly
you just end up with a mess of cake
stuff in your frosting
doesn't look very pretty still tastes
pretty good
but doesn't look very pretty same thing
if we have
those cells that really fragile
beautiful lining of our stomach
is exposed directly to gastric acid it's
not protected well enough by the
bicarbonate
and the mucus then that's how the
gastric acid is going to
injure those mucosal cells it activates
the pepsin that's the enzyme in our
stomach yeah
just chews things up which is great if i
just had a burger
not good if it's digesting my own
stomach lining
now the last two are lifestyle things if
someone already
has peptic ulcer disease well we don't
recommend smoking for anyone
but smoking and alcohol are also
problematic for someone with peptic
ulcer disease
so we would want to encourage the
patient to really limit and if they
could eliminate that would be fantastic
but remember these are very difficult
habits to give up
and so it's not enough to just tell your
patients you have to stop
you want to work with your patients help
them identify how it will help
them and just encourage them educate
them in a
kind and non-judgmental way that hey i
understand that you smoke and you drink
a fair amount of alcohol
this is what it's doing to your stomach
lining so you don't want to be
judgmental we all have things that are
challenging for us
but help the patient decide that that's
a better choice for them
to stop smoking to limit their alcohol
because these things increase their
gastric acid
they make less bicarbonate be produced
in your stomach so then we've got
less ability to neutralize that gastric
acid and so their peptic ulcer disease
takes longer to heal and we can possibly
develop even additional source
so when we're looking at back as we look
back at these i want you to think about
what are the causes of peptic ulcer
disease
well we talked about four major causes
of peptic ulcer disease
without looking at the actual notes see
if you can number those in the margin of
your notes
one two three and four
okay good work so you listed the four
most common causes of peptic ulcer
disease
so for h pylori we're going to use
antibiotics
for nsaids we're going to try to
encourage the patient to limit those as
much as possible
while they still get good pain relief
but we're also going to consider a drug
called misoprostol
now wait a minute it sounds like i'm
going really quickly through this but
i'm just giving you an overview
and then we'll go back through these
medications much more slowly
so we're going to hit those four main
areas kind of give you a quick snapshot
of what we use
and then i'll go over them in much more
detail so for h pylori antibiotics
for nsaids we're going to try to get you
to limit them as much as possible and
consider using misoprostol
for the gastric acid we're going to
consider
histamine receptor antagonists and write
a little h2
next to that because that's the name of
the receptors in the stomach that we're
blocking or antagonizing
proton pump inhibitors next to that just
write
p p i because that's what we'll call
them moving forward
mucosal protectants that's when it's
going to kind of protect that stomach
lining
and then antacids remember those are
over the counter meaning i can buy them
at
cvs or any drugstore and they're not the
most effective
but they work pretty quickly and smoking
while we don't recommend it for anyone
we're going to encourage patients to
stop smoking and
also limit their alcohol use okay
so that is your quick snapshot view and
so i'd kind of mark those as summary
slides as if i just want to remember
hey what are the big overarching
concepts that we're going to talk about
next
that's the key for those slides so let's
talk about h pylori
there's some testing options for h
pylori i told you
lots of us are walking around with it in
fact you can have
it hiding in your body right now but it
doesn't mean you're going to develop
peptic ulcer disease now the test we can
do we can do a serum antibody test
that's a blood test we can do a urea
breath
test which that doesn't involve sticking
you so most people prefer that
or we can do a stomach biopsy whoa that
is
really invasive so we're thinking about
h pylori testing we definitely need to
test people who have peptic ulcer
disease
to see if they have h pylori because if
they do
remember that's a bacteria so we want to
use a minimum
of two antibiotics to treat it now just
as a little sidebar
tuberculosis is another disease process
that we always want to treat with
multiple medications
okay when it comes to treating that
nasty bug h pylori
remember it hides behind my own personal
defenses in my stomach lining
protected from that gastric acid by my
own bicarbonate and mucus
i gotta give it the old one true punch
all right so take a look at those
antibiotics listed at the bottom of your
screen
i want you to read through each one
now take a minute and what do you
remember or what do you recognize about
those drugs
which one of them is a penicillin
remember a clue is
it'll end in psilon
and i also want you to put a giant two
by that note
because you need to remember that you
have to use at least
a minimum of two antibiotics to get rid
of that nasty little critter
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you