Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Pemphigus Vulgaris and Pemphigus Foliaceus Peptic Ulcer Disease 1151

follow-up

During Treatment

■Azathioprine, cyclophosphamide, methotrexate – see Follow-Up

During Treatment for Bullous Pemphigoid

Routine

■Clinical for improvement of skin lesions and development of drug-

related side effects

■Rough correlation of IgG autoantibody titers with disease activity;

the use of desmoglein antibodies by ELISA may be better correlated

with disease activity

complications and prognosis

■Prior to corticosteroids, disease mortality was 100% at 5 years.

■Current mortality <5%, usually due to sepsis associated with imm-

unosuppression

■Chronic course, but spontaneous resolution can occur after 3–5 years

PEPTIC ULCER DISEASE

M. BRIAN FENNERTY, MD

history & physical

History

Risk Factors for Ulcers

■Helicobacter pylori(see section onH. pylori) 50–70%

■NSAIDs 30–40%

■Idiopathic 10–20%

■Smoking increases risk of recurrence of ulcer

Symptoms

■Epigastric pain

■Food may alleviate or worsen symptoms

■Pain usually relieved with acid reduction

■Nausea/vomiting unusual

■Weight loss is unusual unless malignant

■Hematemesis and/or melena if ulcer bleeds

Physical Findings

■Epigastric tenderness

■Melena in bleeding patients