Dyspepsia and Peptic Ulcer Disease

Question 1

what do the ALARM symptoms stand for?

Answer 1

anaemia
Loss of weight 
anorexia 
recent onset 
malaenia/haematemesis 
swallowing difficulty

Question 2

do you get fullness after meals with retrosternal pain?

Answer 2

yes - definitely in gastric

relief after eating for duodenal

Question 3

peptic ulcers can be life-threatening in two ways:

Answer 3

1) peritonitis (perforation into peritoneum)

2) erode into blood vessels - causing upper GI bleeds - patients have discomfort but not acute abdo pain

Question 4

which type of ulcer is more common?

Answer 4

duodenal x4

Question 5

which one occurs more in elderly?

Answer 5

peptic

Question 6

RF for duodenal ulcer

Answer 6

H.pylori (90%)
NSAIDs, steroids
smoking

Question 7

RF for gastric ulcer

Answer 7

H.Pylori (80%)
Smoking
NSAIDS

Question 8

in which type of ulcer is pain relieved by antacids?

Answer 8

BOTH

Question 9

Dx of peptic ulcers?

Answer 9

Upper GI endoscopy
+
test for H.pylori

Question 10

lifestyle changes?

Answer 10

reduce alcohol + smoking

Question 11

if peritonism detected?

Answer 11

IV fluids, Abx, analgesia and NBM

then laparotomy - for peritoneal washout and surgical repair of ulcer

Question 12

If H. pylori +ve - what is the best Tx?

if H.Pylori -ve?

Answer 12

Triple therapy

• give PPI and 2 abx
• lansoprazole, clarithromycin + amoxicillin PO

if -ve: give antacid on its own

Question 13

Antacids

• Which ones are most effective?
• for how long do you give them if they have duodenal or gastric ulcers?
• another type you can give 2nd line is ranitidine - for how long?

Answer 13

• PPI’s (lansoprazole)
• duodenal (4 weeks)
• gastric (8 weeks)
• ranitidine 8 weeks

Question 14

for drug-induced ulcers - what is the Tx?

if symptoms persist post Tx?

Answer 14

stop drugs if possible

PPI’s are best if NSAID/antiplatelet related

if symptoms persist - re-endoscope and retest for H.pylori

Question 15

other causes of dyspepsia?

Answer 15

gastritis
- epigastric pain and vomiting

functional (non-ulcer) dyspepsia
- only Dx after h.pylori eradication and symptoms persist