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 wanna check those out.
But we all know that gram-negative is harder to
treat, bacillus just means the shape of the bug.
You will see that on the reports
when you're looking at those.
Now, the H. Pylori hides in between
the mucus and epithelial cells.
So here's the deal.
Here's why it can survive longer, living in there,
because it's in between the mucus and the epithelial.
So that's why the gastric acid
doesn't kill H. Pylori,
because sadly, 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 them with the mucus
and the prostaglandin and the bicarbonate.
This is actually the most common
cause of peptic ulcer disease.
I know you may have been taught, in
your life, people may have told you,
"Oh, stress is what does it!",
H.Pylori is really the most common
cause of peptic ulcer disease.
So, we talked about H. Pylori, that nasty bug that hides
in between our mucus and it's protected from gastric acid.
Now, let's talk again about NSAIDS.
We briefly discussed 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
answer to that question in the margin of your notes.
Why is the inhibition of prostaglandins
a cause of peptic ulcer disease?
Well remember, prostaglandins are what help keep
us healthy levels of mucus and bicarbonate.
And if you take a drug like NSAIDS, Non-Streroidal
Anti-Inflammatory Drugs that inhibit prostaglandins,
that means we have less of them available,
you have less healthy levels of mucus,
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 doeses 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, let's talk 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're trying to frost it too quickly,
you just end up with a mess of
cake stuff in your frosting.
Doesn't looks very pretty, still taste
pretty good but doesn't look very pretty.
Same thing, if we have those cells that are
really fragile, beautiful linig 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 that (snarls), 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 to our, the lifestyle thing, 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 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 wanna work with your patients, help
them identify how it will help them
and just encourage them, educate them
in a kind and non-judgemental 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 being 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 sores.
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 at the margin of your notes: 1, 2, 3 and 4.
Okay, good work.
So you listed the four most common
causes of peptic ulcer disease.
So for H. Pylori, we're gonna use antibiotics.
For NSAIDS, we're gonna try to encourage the
patient to limit those as much as possible.
While they're still good pain relief but we're
also gonna consider drug called Misoprostol.
Now wait a minute, it sounds like I'm really going quickly
through this. But I'm just giving you an overview
and then we'll go back to these
medications much more slowly.
so we're gonna hit those four main areas, kind
of give you a quick snapshot of what we'll use
and then we'll go over them in much more detail,
so for H. Pylori - antibiotics.
For NSAIDS, we're gonna try to get you to limit them
as much as possible and consider using Misoprostol.
For the gastric acid, we're gonna consider histamine
receptor antagonist 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 PPI
'cause that's what we'll call them moving forward.
Mucosal protectants, that's what's
gonna protect that stomach lining.
and then antacids, remember those are over the counter
meaning I can buy them at CVS or any drugstore.
They're not the most effective
but they work pretty quickly.
And smoking, while we don't
recommend it for anyone,
we're gonna encourage patients to stop
smoking and also limit their alcohol use.
Okay, so that is your quick snapshot view.
So I kinda 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 could have it
hiding in your body right now
but it doesn't mean you're gonna
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.
Woah, 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 side bar,
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 have to give it the one true punch, alright?
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, clue is, it will end in -cillin
And I also want you to put
a giant 2 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.