2.3. Gastric Disease - Peptic Ulcer

Question 1

Are Peptic Ulcers more common in Males or Females?

Answer 1

Males

Question 2

In which age group do Peptic Ulcers appear the most?

Answer 2

The Elderly

Question 3

What are the commonest causes of Peptic Ulceration?

Answer 3

1. Helicobacter Pylori infection

2. NSAID irritation

Question 4

What are some rare causes of Peptic Ulceration?

Answer 4

1. Zollinger-Ellison Syndrome
2. Hyperparathyroidism
3. Crohn’s Disease

Question 5

What has been proven to be related to Peptic Ulceration?

Answer 5

Smoking

Question 6

What is the pathology of Peptic Ulceration?

Answer 6

1. The Aetiology (H. Pylori/NSAID’s usually) causes excess Gastric Acid to be produced
2. The Excess Gastric Acid damages the Gastric Mucosa and results in Ulceration

Question 7

What are the Clinical Signs of Peptic Ulceration?

Answer 7

1. Anorexia leading to Weight Loss
2. Haematemesis
3. Melena
4. Anaemia
5. Signs of H. Pylori Infection

Question 8

What are the Signs of H. Pylori Infection?

Answer 8

1. Raised White Cell Count
2. Serum IgG
3. Serum Inflammatory Markers (CRP and ESR)

Question 9

Why does Anorexia and Weight loss occur?

Answer 9

Due to the Pain on eating

Question 10

Why does the Haematemesis, Melena, and Anaemia occur?

Answer 10

Due to the bleeding from the Peptic Ulcer into the Gastrointestinal Tract

Question 11

What is Melena?

Answer 11

Partially digested (Black/Tar-like) blood in stool

Question 12

What would a patient with a Peptic Ulcer present with?

Answer 12

1. Epigastric Pain
2. Nocturnal / Hunger Pain
3. Back Pain
4. Nausea / Vomiting

Question 13

Why does the Epigastric Pain occur?

Answer 13

Due to the damage to the Gastric Epithelium

Question 14

Why is the pain worse at night / when hungry?

Answer 14

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

Question 15

Why is there pain in the back?

Answer 15

The pain radiates there from the Stomach

Question 16

Why does the Nausea and Vomiting occur?

Answer 16

1. The Abnormal Nature of the Peptic Ulcer

2. The Pain when eating

Question 17

What investigation is needed for Peptic Ulceration?

Answer 17

1. Upper G.I. Endoscopy

2. Potential Biopsy (Severity Dependent)

Question 18

What is the Purpose of the Upper G.I. Endoscopy?

Answer 18

1. To identify where the Ulcer is
2. To view the Severity of the Ulcer
3. To try to find the causative agent

Question 19

What is the treatment of a Peptic Ulcer?

Answer 19

1. NSAID Cessation (if that is the cause)
2. Eradication Therapy (if H. Pylori is the cause)
3. Proton Pump Inhibitors
4. H2 Receptor Antagonists

Question 20

What is Eradication Therapy?

Answer 20

The Therapy used for treating H. Pylori:

Carithromycin + Amoxicillin (Tetracycline if Alergic) + Omeprazole

Question 21

What complications can occur from a Peptic Ulcer?

Answer 21

1. Acute Bleeding
2. Chronic Bleeding
3. Perforation
4. Fibrotic Stricture
5. Gastric Outlet Obstruction

Question 22

What can Acute / Chronic Bleeding lead to?

Answer 22

1. Haematemesis
2. Melena
3. Iron Deficiency (Anaemia)

Question 23

What can Perforation lead to?

Answer 23

Gastric Contents leaking out into the Peritoneal Cavity

Question 24

What is Fibrotic Stricture a result of?

Answer 24

Cellular Damage