Dyspepsia Flashcards
If someone with dyspepsia tests positive for H pylori infection, what treatment do we give?
Triple therapy
PPI (omeprazole) and 2 antibiotics (clarithryomycin and amoxicillin)
Are duodenal or gastric ulcers more common?
Duodenal (4x more common)
What is the major risk factor for duodenal ulcers causing 90% of ulcers? What are some other risk factors for duodenal ulcers?
Helicobacter pylori infection
Drugs (NSAIDs, steroids, SSRIs), Increased gastric secretion or decreased gastric emptying, low duodenal pH, smoking.
What are some signs or symptoms of duodenal ulceration?
Asymptomatic or may have. epigastric pain and tenderness (relieved by antacids), can have decreased weight.
How do we diagnose a duodenal ulcer?
Upper Gi endoscopy
Test for H pylori
What are the risk factors for gastric ulcers?
H pylori (80%) Smoking NSAIDs Stress Reflux of duodenal contents
How can mucosal ischaemia lead to gastric ulcers? What can we do to treat this?
Lack of blood to the gastric mucosa causes gastric cells to not function properly, mucin layer not produced, acid penetrates and kills gastric cells leading to an ulcer.
Treatment:
Reverse ischaemia through blood transfusion to increase BP
Reduce stomach acid using H2 blocker or PPI
What are 3 things which can cause an increase in stomach acid leading to gastric ulcers?
Stress
H pylori
Aspirin/NSAIDs
Enteric coated aspirin can be used to reduce risk of gastric ulcers
How can alcohol cause gastric ulcers?
Undiluted alcohol (spirits) can erode the lining of the stomach and cause ulceration
What test would we perform if someone has a gastric ulcer?
Upper GI endoscopy to exclude malignancy with multiple biopsies from the ulcer rim and base
Repeat endoscopy 6-8 weeks to confirm it is healing
What are some risk factors for gastritis?
Alcohol NSAIDs H pylori Reflux CMV Atrophic gastritis
What complications are associated with gastro-duodenal ulcers?
Ulcer can erode through the duodenal wall, and into arteries lying behind the duodenum (gastro-duodenual artery) causing haemorrhage.
Ulcer can also erode posteriorly into the pancreas causing pancreatitis or can erode downwards causing peritonitis.
What are the symptoms of dyspepsia?
Epigastric pain
Reflux or heart burn
Fullness after meals
What are the ALARM symptoms of dyspepsia?
Anaemia Loss of weight Anorexia Recent or progressive symptoms Melena or haematemesis
Overall treatment for dyspepsia?
Lifestyle: reduce alcohol and tobacco use
H pylori eradication: triple therapy
Drugs to reduce acid: PPIs, H2 blockers
Drug induced ulcers: stop offending drug if possible, PPIs, misoprostol.
