Dyspepsia + Peptic Ulcers Flashcards
What is Dyspepsia?
Epigastric pain or burning.
What are the two categories of causes of Dyspepsia?
Organic - 25%
(e.g. Peptic ulcer disease, Drugs (NSAIDs, COX2 inhibitors), gastric cancer)
Functional - 75%
(e.g. idiopathic, associated with IBS etc.)
On examination what would you find in uncomplicated and in complicated Dyspepsia?
Uncomplicated - Tenderness only.
Complicated - Cachexia, mass, evidence of gastric outflow obstruction, peritonism
For treatment of Dyspepsia what are the Alarm features that would cause you to send the patient to a specialist?
Dysphagia Evidence of GI blood loss Recurrent vomiting Unexplained weight loss Upper abdominal mass
What should you consider in uncomplicated dyspepsia?
Lifestyle changes
Antacids
If symptoms persist after lifestyle consideration and antacid use what is the next move?
H. pylori test.
If positive then eradicate
After H. pylori is negative or eradicated then consider the patients age, what would happen now?
> 54 see a specialist
How would you diagnose an infection of H.pylori?
Urease breath test
Biopsy - histology, culture/sensitivity
Faecal antigen test
What is the treatment of Peptic ulcer Disease?
PPI Test for H.pylori - (if +ve - Eradicate and confirm) - (if -ve - Antisecretory therapy) Withdraw NSAIDs lifestyle change
For non-Hp/NSAID ulcers - Nutrition and optimise comorbidities
In the treatment of H.pylori infection what would be the commonest drugs used in week 1?
PPI + Amoxycillin + Clarithromycin
(or)
PPI + Metronidazole + Clarithromycin
What are the complications of peptic ulcer disease?
Anaemia
bleeding
perforation
gastric outlet/duodenal obstruction - fibrotic scar
What would you do to follow up treatment for a Gastric Ulcer?
Endoscopy at 6-8 weeks to ensure healing and no malignancy.
