Dyspepsia, Peptic ulcer, gastroparesis

Question 1

presentation of dyspepsia

Answer 1

upper abdominal pain or discomfort, heartburn,
acid reflux,
nausea
vomiting.
Uncomfortable feeling in epigastric area resulting from impaired digestion

Question 2

common causes of peptic ulcer disease

Answer 2

H.Pylori infection
LT use of NSAIDs

Question 3

presentation/symptoms of peptic ulcer disease

Answer 3

BURNING or GNAWING pain

Question 4

risk factors for dyspepsia

Answer 4

Younger age
Female sex
Higher levels of somatoform-type symptoms reporting
IBS
Psychological comorbidity (new onset symptoms more likely in those with history of anxiety or depression)
Enteric Infection
High BMI
NSAIDs
H. Pylori (although this is organic cause but many people have symptoms following erradicaition)

Question 5

pathophysiology of dyspepsia is uncertain, but there is a proposed model. True or False

Answer 5

true

Question 7

H pylori is gram negative. true or false

Answer 7

true

Question 8

how is h pylori spread

Answer 8

oral-oral / faecal oral

Question 9

infection with h pylori recruits what type of wbcs

Answer 9

neutrophils
neutrophilic gastritis

Question 10

Diagnosis of H.Pylori infection

Answer 10

Gastric biopsy:
Urease test
Histology
Culture/sensitivity
Urease breath test
FAT (faecal antigen test)
Serology (IgA antibodies) not accurate with increasing patient age

CLO test - urease test

H. pylori increases pH of its microenvironment
Secretes urease which catalyzes conversion of urea to ammonia
Urease test changes acid to ammonium bicarbonate

Question 12

treatment of peptic ulcer disease

Answer 12

All get antisecretory therapy (PPI)
All get tested for presence of H. pylori
H.pylori +ve – eradicate and confirm
H. pylori –ve – antisecretory therapy
Stop NSAIDS
Lifestyle changes
Non-HP/non-NSAID ulcers – nutrition and optimise comorbidities
No firm dietary recommendations
Surgery infrequent

Question 13

treatment of H.Pylori infection (eradication therapy)

Answer 13

“Triple therapy” for 1 week commonest (85% success)
1st line: PPI, amoxicillin and either clarithromycin or metronidazole
2nd line: PPI, amoxicillin and whichever wasn’t used first line
3rd line “quadruple therapy”: PPI, bismuth subsalicylate (unlicensed) and either 2 antibiotics not used previously or rifabutin or furazolidone
S/E’s common (nausea, diarrhoea): compliance
If still symptomatic – re-test

Question 14

complications of peptic ulcer disease

Answer 14

anaemia
vleeding
perforation
gastric outler/ duodenal obstruction / fibrotic scar