2.3. Gastric Disease - Peptic Ulcer Flashcards
Are Peptic Ulcers more common in Males or Females?
Males
In which age group do Peptic Ulcers appear the most?
The Elderly
What are the commonest causes of Peptic Ulceration?
- Helicobacter Pylori infection
2. NSAID irritation
What are some rare causes of Peptic Ulceration?
- Zollinger-Ellison Syndrome
- Hyperparathyroidism
- Crohn’s Disease
What has been proven to be related to Peptic Ulceration?
Smoking
What is the pathology of Peptic Ulceration?
- The Aetiology (H. Pylori/NSAID’s usually) causes excess Gastric Acid to be produced
- The Excess Gastric Acid damages the Gastric Mucosa and results in Ulceration
What are the Clinical Signs of Peptic Ulceration?
- Anorexia leading to Weight Loss
- Haematemesis
- Melena
- Anaemia
- Signs of H. Pylori Infection
What are the Signs of H. Pylori Infection?
- Raised White Cell Count
- Serum IgG
- Serum Inflammatory Markers (CRP and ESR)
Why does Anorexia and Weight loss occur?
Due to the Pain on eating
Why does the Haematemesis, Melena, and Anaemia occur?
Due to the bleeding from the Peptic Ulcer into the Gastrointestinal Tract
What is Melena?
Partially digested (Black/Tar-like) blood in stool
What would a patient with a Peptic Ulcer present with?
- Epigastric Pain
- Nocturnal / Hunger Pain
- Back Pain
- Nausea / Vomiting
Why does the Epigastric Pain occur?
Due to the damage to the Gastric Epithelium
Why is the pain worse at night / when hungry?
As this is the time when the Gastric Acid is more concentrated, due to the anticipation of food, and so the Ulcer will be damaged firther
Why is there pain in the back?
The pain radiates there from the Stomach
Why does the Nausea and Vomiting occur?
- The Abnormal Nature of the Peptic Ulcer
2. The Pain when eating
What investigation is needed for Peptic Ulceration?
- Upper G.I. Endoscopy
2. Potential Biopsy (Severity Dependent)
What is the Purpose of the Upper G.I. Endoscopy?
- To identify where the Ulcer is
- To view the Severity of the Ulcer
- To try to find the causative agent
What is the treatment of a Peptic Ulcer?
- NSAID Cessation (if that is the cause)
- Eradication Therapy (if H. Pylori is the cause)
- Proton Pump Inhibitors
- H2 Receptor Antagonists
What is Eradication Therapy?
The Therapy used for treating H. Pylori:
Carithromycin + Amoxicillin (Tetracycline if Alergic) + Omeprazole
What complications can occur from a Peptic Ulcer?
- Acute Bleeding
- Chronic Bleeding
- Perforation
- Fibrotic Stricture
- Gastric Outlet Obstruction
What can Acute / Chronic Bleeding lead to?
- Haematemesis
- Melena
- Iron Deficiency (Anaemia)
What can Perforation lead to?
Gastric Contents leaking out into the Peritoneal Cavity
What is Fibrotic Stricture a result of?
Cellular Damage
