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CC July 2018 Gastric Ulcer Prophylaxis

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echoecho's version from 2018-09-04 05:18

Section

Question Answer
Define stress ulceration?it is a subtype of hemorrhagic gastritis that is more common in patients admitted to the hospital following major trauma nd those who are critically ill
In critically ill patients, what is the incidence of occult bleeding? Overt bleeding? Clinically significant bleeding?15-50%; 4-25%; 1.5 - 3.5%
What is the pathophysiology of stress ulcers?an imbalance between protective factors and aggravating factors
What is the pathophysiology exacerbated by?poor mucosal blood flow and subsequent reperfusion that is often seen in those who are critically ill
List the factors that decrease the incidence of stress ulcers?1) improved resuscitation 2) earlier initiation of enteral feeding 3) reduced use of high-dose steroids
What is the role of stress ulcer prophylaxis in factors that reduce the incidence of stress ulcers?role is unclear
List the risk factors for development of stress ulcers?1) mechanical ventilation for > 24 hours 2) thrombocytopenia 3) coagulopathy/elevated INR 4) severe burns 5) significant neurological injury (subarachnoid hemorrhage) 6) acute liver failure 7) decreased renal function
List the other factors that been suggested but are not well studied?1) sepsis 2) prolonged ICU stay 3) occult GI bleeding for several days 4) alcohol abuse 5) high-dose corticosteroid use
Are the following risk factors for stress ulcers (age, anemia, noninvasive positive pressure ventilation, the need for venous thromboembolism prophylaxis)?no
What 2 medications have been used to prevent the development of stress ulcers?1) histamine-2 receptor blockers 2) PPI
A 2010 meta-analysis compared the efficacy and safety of H2 blockers and PPIs, what were their findings?there was no statistically significant difference between H2blockers and PPIs in the incidence of upper GI bleeding, pneumonia or mortality
A subsequent meta-analysis of 57 randomized, controlled trials showed moderate-quality evidence that which of the two (PPIs or H2 blockers) had a greater benefit, but the absolute benefit was not large?PPIs had a greater benefit than H2 blockers
Patients receiving PPIs had a higher risk of ________ and a possible risk of _______ infection?pneumonia; C. difficile
Because of the above, it could be concluded that the overall results "call into question the _____ benefits of stress ulcer prophylaxis and its widespread use"?net
A small 2017 study comparing the PPI Pantoprazole to placebo showed what?a trend to lower incidence of ventilator-associated pneumonia and C difficle infections in the placebo group
There is preliminary evidence that the use of what medication may also reduce the risk of stress ulcer development?sucralfate (Carafate)
*** Overall, it appears prudent to consider medications for stress ulcer prophylaxis in _____ risk patients but not for ____ risk patients?high; low
*** Medical stress ulcer prophylaxis may NOT be necessary when _____ feeding is administered?enteral
*** SUMMARY = Define stress ulceration?It is a subtype of hemorrhagic gastritis found in patients admitted to the hospital following major trauma and in those who are critically ill
*** SUMMARY = Severity ranges from _____ bleeding to clinically significant blood loss?occult
*** SUMMARY = List the risk factors for stress ulceration?1) mechanical ventilation > 24 hours 2) thrombocytopenia 3) coagulopathy 4) severe burns 5) significant neurological injury 6) chronic renal disease 7) acute liver disease
*** SUMMARY = True or false? Use of medications for stress ulcer prophylaxis is recommended for patients at highrisk; for low-risk patients, medication risks may outweigh potential benefits?true
*** SUMMARY = Early ______ feeding is advised when possible to reduce the risk of stress ulcerstrue
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