Gastro - Ulcers

Question 1

Peptic ulcer definition? Types? Which is more common?

Answer 1

Ulceration of the gastric mucosa. We have gastric and duodenal ulcers.

Duodenal ulcers are more common and occur in the proximal duodenum

Question 2

Pathophysiology of peptic ulcers

Answer 2

Mucosa is broken down by causes or increased stomach acid. Typically, the stomach produces mucus and bicarbonate to protect the stomach and neutralise the acid, however the causes can either disrupt the mucus barrier or increased stomach acid leading to an increased risk of mucosal ulceration.

Typically, in gastric ulcers there is impairment of mucosal protection while in duodenal ulcers there is oversecreting of acid.

Question 3

Risk factors of peptic ulcers?
*Technically can be called causes for some

Answer 3

H. pylori infection
Use of NSAIDs or steroids
Stress
Caffeine
Spicy food
Alcohol
Smoking
Sex (male)

Question 4

Which drugs cause an increased risk of bleeding from a peptic ulcer?

Answer 4

NSAIDs
Aspirin
Anticoagulants (DOACs – apixaban, betrixaban)

Question 5

Clinical presentation of ulcers?

Answer 5

dyspepsia.
Epigastric pain or discomfort
iron deficiency anemia
Nausea and vomiting
Melena or coffee ground vomiting (if there is ulcer bleeding)

Question 6

What can we learn about ulcers from pt eating habits?

Answer 6

Eating can worsen or improve ulcers. If it worsens, it is probably a gastric ulcer.
While if it improves it is probably a duodenal ulcer

Question 7

Dx of ulcers?

Answer 7

Endoscopy
Rapid urease test (CLO test) – check for Pylori

Biopsy – exclude cancer. Must do with gastric ulcers

Question 8

Tx of peptic ulcers:

Answer 8

Cease NSAIDs
High dose PPI (omeprazole, lansoprazole)
Treat Pylori infection if present

Endoscopy to monitor healing and check for new ulcers

Question 9

Complication of Ulcers:

Answer 9

1. Bleeding: low level can cause iron deficiency anemia or excessive bleeding could be life threatening
2. Perforation – hole in stomach causing gastric contents to leak out. Can develop into acute abdomen or peritonitis, requiring emergency surgery.
   Mallory-Weiss tear
3. Scarring and strictures – healing of ulcer turns into scar tissue which can cause narrowing of pylorus  pyloric stenosis, presenting with upper Abdo pain, reflux, distention, nausea and vomiting