FN: Peptic Ulcer Disease

Question 1

Classification

Answer 1

Acute or Chronic

Question 2

Acute

Answer 2

Usually due to drugs (NSAIDS, steroids) or stress

Question 3

Chronic

Answer 3

Drugs
H. Pylori
Raised Calcium
Zollinger Ellison

Question 4

Two types

Answer 4

Duodenal Ulcers

Gastric Ulcers

Question 5

Duodenal Ulcers path

Answer 5

4x commoner than GU
1st part of duodenum (Cap)
M>F

Question 6

duodenal Ulcers RF

Answer 6

H. Pylori
Drugs: NSAIDS, steroids
Smoking
EtOH
Increased gastric emptying
Blood group O

Question 7

Duodenal Ulcers presentation

Answer 7

Epigastric Pain:
Before meals and at night
Relieved by eating or milk

Question 8

Gastric Ulcers path

Answer 8

Lesser curve of gastric antrum

Beware ulcers elsewhere (often malignant)

Question 9

Gastric Ulcers Risk factors

Answer 9

H. pylori
Smoking
Drugs
Delayed gastric emptying
Stress:
1. Cushings: intracranial disease
2. Curling:L burns, sepsis, trauma

Question 10

Gastric Ulcers presentation

Answer 10

Epigastric pain

1. Worse on eating
2. relieved by antacids

Wt. loss

Question 11

Complications

Answer 11

Haemorrhage
Perforation
Gastric Outflow Obstruction
Malignancy

Question 12

Haemorrhage

Answer 12

Haematemeis or melaena

Fe deficiency anaemia

Question 13

Perforation

Answer 13

Peritonitis

Question 14

Gastric Outflow Obstruction

Answer 14

Vomiting, colic, distension

Question 15

Malignancy

Answer 15

Raised risk with H. pylori

Question 16

Investigations

Answer 16

Bloods: FBc, urea (raised in haemorrhage)
C(13) breath test
OGD (stop PPIs >2 wks before)
Gastrin levels if Zollinger-ellison suspected

Question 17

OGD process

Answer 17

CLO/urease test for H.pylori

Always take biopsies of ulcers to check for Ca

Question 18

Management

Answer 18

Consverative
MEdical
surgical

Question 19

Conservative

Answer 19

Lose wt.
Stop smoking and reduced EOH
Avoid hot dirnks and spicy food
Stop drugs: NSAIDS, steroids
OTC antacids

Question 20

Medical

Answer 20

1. OTC antacids: Gaviscon, Mg trisilicate
2. H. pylori eradication
3. Full-dose acid suppression for 1-2 mo
   - PPIs: lansoprazole 30mg OD
   - H2RAs: ranitidine 200mg nocte
4. Low-dose acid suppressionPRN

Question 21

Surgery for PUD Concepts

Answer 21

No acid -no ulcer

Secretion stimulated by gastrin and vagus N.

Question 22

Vagotomy

Answer 22

Truncal: reduce acid secretion but prevents pyloric sphincter relaxtion therefore must by combined with pyloroplasty or gastroenterostomy

Selective: vagus nerve only denervated where it supplies lower oesophagus and stomach - nerves of laterjet (supply pylorus) left intact

Question 23

Antrectomy with vagotomy

Answer 23

Distal half of stomach removed _ anastomosis:

1. directly to duodenum: billroth 1
2. To small bowel loop w/ duodenal stump oversenL billroth 2 or polyp

Question 24

Subtotal gastrectomy with Roux-en-Y

Answer 24

Occasionally performed for Zollinger-Ellison

Question 25

occasional physical

Answer 25

Stump eakage
Abdominal fullness
REflux or bilious vomiting (improves with time)
Stricture

Question 26

Complications Metabolic

Answer 26

Dumping syndrome:

1. abdo distension, flushong, n.v
2. Early: osmotchypovolaemia
3. Late: reactive hypoglycaemia

Blind loop syndrome - malabsorption, diarrhoea
-Overgrowth of bacteria in duodenal stump
-Anaemia: Fe + B12
Osteoporosis

Wt. loss: malasborption of reduced calories intake