23. Peptic Ulcer Disease and GI Bleeding Flashcards
What are the causes of peptic ulcer disease?
H.pylori and NSAIDs Alcohol, smoking Reflux, gastric hyperactivity Shock and ischaemia Reduced gastric emptying Zollinger-Ellison Syndrome
What drug should be given to diabetics to increase gastric emptying?
Macrolide antibiotics
What is the difference between gastric and duodenal ulcers in a history?
Gastric are worse after eating, duodenal are worse when hungry
What features of a GI history are concerning?
Anaemia Loss of weight Anorexia and earlier satiety Recent onset Malaenia/haematemesis
What signs indicate haemodynamic instability?
Low BP
Tachycardia
Altered mental status
What score predicts mortality from a GI bleed?
Blatchford score
What blood tests should be done in a GI bleed?
FBC for Hb
Type and screening for blood donor
Urea (high urea indicates bleeding)
Why is an urgent endoscopy carried out in a GI bleed?
CLO testing (campylobacter-like organism)
Biopsy
Clips and adrenaline treatment
Haemospray (stabilise ulcer)
What can give a false negative CLO result?
PPI treatment
Antibiotics
Recent GI bleed
What is the acute management of non-bleeding peptic ulcers?
PPIs
H2 receptor antagonists if PPIs contraindicated
Gaviscon
What are the side effects of PPIs?
Hyponatraemia
C.diff
What is the long term management of PUD?
Stop NSAIDs, avoid alcohol and smoking Weight loss (high BMI= incompetent LES) Repeat OGD after triple therapy Highly selective vagotomy
What is Zollinger-Ellison syndrome?
Pancreatic or intestinal tumour that secretes gastrin
Causes duodenal ulcers that don’t heal with PPI or H2
What are the clinical features of Zollinger-Ellison syndrome?
Diarrhoea
High serum gastrin
High Ca++ as associated with parathyroid adenoma
Endocrinopathy: associated with MEN 1
What is used to distinguish between upper and lower GI bleeding?
Ligament of Treitz