GI: Peptic Ulcer Disease Flashcards
1
Q
What is peptic ulcer disease? Describe the possible causes for this.
A
PUD = breach in gastric or duodenal mucosa, extending through muscularis mucosa, secondary to gastric acid.
Most commonly affects posterior wall or early duodenum or lesser curve of stomach.
Causes:
- H. pylori infection (associated with 95% duodenal ulcers and 80% gastric ulcers)
- NSAID or corticosteroid use (breakdown of mucosal defence mechanisms due to inhibition of prostaglandin synthesis)
- Severe physiological stress, e.g. burns, RICP
- Zollinger-Ellison syndrome (gastrin-secreting gastrinoma)
2
Q
describe the presentation of peptic ulcer disease
A
- Severe constant epigastric pain (may radiate to back if posterior ulcer) - burning/gnawing usually 1-3 hrs post-prandial.
- Aggravated by eating if gastric, relieved by eating if duodenal.
- Nausea, bloating, distension
- +/- heartburn
3
Q
which tests would you perform in a pt with suspected PUD?
A
- Carbon-13 urea breath test for H. pylori (or stool antigen test)
- Endoscopy to confirm ulceration and for biopsy, IF pt >55 yo at 1st presentation, or presence of red flags
4
Q
how would you manage a pt with PUD who is H. pylori +ve? -ve?
A
- Lifestyle modification: stop NSAIDs if possible, stop smoking
- If H. pylori +ve: 7 days of triple therapy for eradication - PPI + clarithromycin + amoxicillin
- If H. pylori -ve: 4-8 wks PPI
Review at end of Tx course, e.g. f/u urea breath test after eradication.
5
Q
describe 2 possible complications of PUD?
A
- Upper GI tract haemorrhage (14%): haematemesis or melaena as a result of deep ulcers eroding into underlying blood vessels (usually L gastric artery or gastroduodenal artery)
- Perforation (6%): peritonitis