Pediatric emergency medicine trisk 2054 2054

H2 -receptor antagonists (e.g., ranitidine or famotidine) are used to block
acid secretion and treat ulcer disease. Alternatively PPIs (e.g., omeprazole or
lansoprazole) can be used and are more effective at decreasing gastric acid
secretion than H2 -receptor antagonists. PPIs should be used in patients with
anemia or who have moderate to severe PUD. Potential short-term adverse
effects with PPI usage include headache, abdominal pain, diarrhea, nausea,
and vomiting. When initiating therapy, follow-up is important, as is providing
a sufficient quantity so that the child can take the medication until the
outpatient visit has occurred.
Sucralfate (40 to 80 mg/kg/day by mouth every 6 hours) is a sucrose sulfate
and aluminum hydroxide salt that creates a gel over the mucosal surface and
insulates the gastric mucosa from further damage by acid, pepsin, or bile. It is
recommended to be given on an empty stomach 1 hour before meals and at
bedtime, and not given at the same time as other medications given its ability
to bind them.
Current protocols for first-line therapy for H. pylori include a PPI plus two
antibiotics (choosing two of the following: amoxicillin, clarithromycin, or
metronidazole for 10 to 14 days). Compliance is an important consideration
because it is a major determinant of the success of treatment. Antibiotic
susceptibility testing for clarithromycin is recommended before initial
clarithromycin-based triple therapy in areas/populations with a known high
resistance rate (>20%) as this will adversely affect eradication rates.

MALLORY–WEISS TEARS/PROLAPSE GASTROPATHY
Mallory–Weiss tears are mucosal lacerations of the distal esophagus and
proximal stomach induced by forceful retching. Patients typically present with
a recent history of repeated vomiting prior to onset of the hematemesis and
less frequently, with pain from the tear. While the amount of blood can vary,
Mallory–Weiss tears usually are self-limited and do not require any medical or
surgical intervention. Upper GI bleeding after retching or vomiting may also
be due to prolapse gastropathy, when the stomach prolapses through the lower

esophageal sphincter causing mucosal injury. Management is generally
conservative with antiemetic therapy, PPI, and observation.

LOWER GI BLEEDING
Inflammatory Bowel Disease