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GIHEP > 23. Peptic Ulcer Disease and GI Bleeding > Flashcards

23. Peptic Ulcer Disease and GI Bleeding Flashcards

1
Q

What are the causes of peptic ulcer disease?

A 
H.pylori and NSAIDs
Alcohol, smoking
Reflux, gastric hyperactivity
Shock and ischaemia
Reduced gastric emptying
Zollinger-Ellison Syndrome
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2
Q

What drug should be given to diabetics to increase gastric emptying?

A

Macrolide antibiotics

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3
Q

What is the difference between gastric and duodenal ulcers in a history?

A

Gastric are worse after eating, duodenal are worse when hungry

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4
Q

What features of a GI history are concerning?

A 
Anaemia
Loss of weight
Anorexia and earlier satiety
Recent onset
Malaenia/haematemesis
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5
Q

What signs indicate haemodynamic instability?

A

Low BP
Tachycardia
Altered mental status

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6
Q

What score predicts mortality from a GI bleed?

A

Blatchford score

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7
Q

What blood tests should be done in a GI bleed?

A

FBC for Hb
Type and screening for blood donor
Urea (high urea indicates bleeding)

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8
Q

Why is an urgent endoscopy carried out in a GI bleed?

A

CLO testing (campylobacter-like organism)
Biopsy
Clips and adrenaline treatment
Haemospray (stabilise ulcer)

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9
Q

What can give a false negative CLO result?

A

PPI treatment
Antibiotics
Recent GI bleed

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10
Q

What is the acute management of non-bleeding peptic ulcers?

A

PPIs
H2 receptor antagonists if PPIs contraindicated
Gaviscon

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11
Q

What are the side effects of PPIs?

A

Hyponatraemia

C.diff

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12
Q

What is the long term management of PUD?

A 
Stop NSAIDs, avoid alcohol and smoking
Weight loss (high BMI= incompetent LES)
Repeat OGD after triple therapy
Highly selective vagotomy
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13
Q

What is Zollinger-Ellison syndrome?

A

Pancreatic or intestinal tumour that secretes gastrin

Causes duodenal ulcers that don’t heal with PPI or H2

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14
Q

What are the clinical features of Zollinger-Ellison syndrome?

A

Diarrhoea
High serum gastrin
High Ca++ as associated with parathyroid adenoma
Endocrinopathy: associated with MEN 1

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15
Q

What is used to distinguish between upper and lower GI bleeding?

A

Ligament of Treitz

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16
Q

What is haematochezia?

A

Bright blood from the rectum

17
Q

What is the differential for a lower GI bleed?

A 
Anal fissure, haemorrhoids
IBD
Infective colitis
Cancer of colon or rectum
Ischaemia colitis
Diverticulitis
18
Q

What score is used to assess duodenal ulcers?

A

Rockall score

GIHEP (30 decks)

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