complications of peptic ulcers Flashcards
what are the most important contributing factors to peptic ulcers ?
H.pylori
NSAIDs
acid and pepsin
what are the most important protective factors ?
mucus bicarbonate mucosal blood flow prostaglandins hydrophobic layer epithelial renewal
what is considered the gold standard of h.pylori infection ?
histological identification
what are the methods of detection of H.pylori ?
histological identification microbiological culture urease breath test rapid urease test serology for H.pylori antigen stool antigen test
which of the H.pylori tests require prior preparation ?
stool antigen test
urease breath test ( need to strop antibiotics and anti-acid medications)
what are one of the methods of detection of blood in the stool ?
guaic stool test
what is a succussion splash ?
is a sloshing sound heard through a stethoscope during sudden movement of the patient on abdominal auscultation
what are the differential diagnosis ?
MI neoplasm pancreatitis pancreatic cancer diverticulitis GERD
what is the treatment plan for h.pylori ?
triple therapy:
Amoxicillin + Clarithomycin + Proton Pump Inhibitor
what is the treatment plan for a non h.pylori peptic ulcer?
proton pump inhibitor
H2 receptor antagonists to assist ulcer healing
treatment plan for up to 8 weeks
what are the complications of peptic ulcer disease ?
bleeding
perforation
obstruction
what is the presentation of gastrointestinal bleeding ?
tarry stool or coffee ground emesis
what is the presentation of perforation ?
history of PUD
air under diaphragm
abdominal tenderness
what is the presentation of gastric outlet obstruction ?
pain worsening with food non-billous vomiting hypokalemia hyponatremia weight loss
what is the treatment for gastric outlet obstruction ?
endoscopic balloon dilatation
truncal vagotomy
what is the most common complication of peptic ulcers ?
bleeding peptic ulcer
what is the most likely prognosis of bleeding peptic ulcer?
self-limiting
what is the next best step in management in melena or hematemsis ?
1.in a stable patient : consider IV PPI therapy, along with early endoscopy within 24 hours along with early discharge 2.in an unstable patient: urgent endoscopy endostasis + IV PPI infusion
If there is re-bleeding in an unstable patient with hematemesis or melena what is the next best step in management ?
consider :
repeat endostasis
mesenteric angiography/embolisation
surgery
what are the levels of bleeding in peptic ulcers ?
- on a microscopic level
- mild
- moderate
- severe
what is the clinical presentation of a bleeding peptic ulcer ?
hematemesis
melena / tarry stool
manifestations of progressive shock
how to exclude false hematemesis ?
examination of the nose and pharynx
what is the most common cause of hematemesis ?
bleeding varicies
what is an important cause of hematemesis that must be excluded ?
portal hypertension
what are the investigations required for bleeding peptic ulcer?
when the general condition of the patient is stabilized then an upper GI endoscopy
when would testing for hematocrit ad haemoglobin be appropriate ?
hematocrit and haemoglobin is only useful a few hours after haemdilution
what is the treatment for a bleeding peptic ulcer?
most of these cases stop spontaneously
conservative treatment should always be considered
when should PPIs be started ?
they should be delayed until the first endoscopy is performed
what are the endoscopic treatment options for bleeding peptic ulcers ?
injections with adrenaline
heat probes
haemostatic clips
what is the next step in management if endoscopic therapy fails in a bleeding peptic ulcer ?
selective arterial embolisation prior to surgical intervention
what are the indications of endoscopis treatment ?
ulcer seen to be actively bleeding
stigmata of recent bleeding
when there is severe bleeding in a bleeding peptic ulcer which artery is most likely to be affected ?
gastroduodenal artery which can be fatal
what are the signs indicating perforated PU ?
air under diaphragm on Xray
what is the treatment for Perforated PU?
resuscitate with fluids crystalloids
IV ab if there is bacterial peritonitis
what are the two types of obstructing peptic ulcer ?
acute from inflammatory swelling
chronic from cicatrix
what are the complications of obstructing peptic ulcer ?
Antral stenosis
respiratory infection due to aspiration of vomit
