Dyspepsia and Peptide Ulcer Disease Flashcards
dyspepsia
epigastric pain or burning
postprandial fullness
early satiety
dyspepsia - causes
ORGANIC
peptic ulcer disease, drugs, gastric cancer
FUNCTIONAL
idiopathic
structural disease and functional gut disorders
dyspepsia - examination
epigastric tenderness
COMPLICATED cachexia mass evidence gastric outflow obstruction peritoneum
peptic ulcer disease
cause of organic dyspepsia
pain predominant dyspepsia (to back)
often also nocturnal
aggravated or relieved by eating
gastric =pain
duendenal = no pain
relapsing and remitting chronic illness
family history
peptic ulcer disease - causes
h.pylori
90% of DU
60% of GU
NSAIDs
h.pylori
acquired in infancy
gram -ve microaerophilic flagellated bacillus
oral-oral/faecal oral spread
consequences arrive later in life
h.pylori - consequences
no pathology
peptide ulcer disease
gastric cancer
h.pylori - diagnosis
gastric biopsy
urease test
histology
culture/sensitivity
urease breath test
FAT (faecal antigen test)
serology (IgA antibiotics) - not accurate with increasing patient age
h.pylori increases pH of its microenvironment
produces ammonium bicarbonate
catalysed by urease
treatment of PUD
all antisecretory therapy PPI
all tested for presence of H.pylori
+ve = eradicate and confirm
-ve = antisecretory therapy
withdraw NSAIDs
lifestyle
eradication therapy
triple therapy for 1 week commonest
PPI + amoxycillin + clarithromycin
2 week regimens
higher eradication rates
poorer compliance
dual therapy
quadruple therapy
complications of PUD
anaemia
bleeding
perforation
gastric outlet/duodenal obstruction - fibrotic scar