Lecture 2 - Peptic Ulcer Disease and GORD Flashcards
What percentage of the population suffer from dyspepsia anually?
40%
leads to primary care consultation in 5% and endoscopy in 1%
Of those who undergo endoscopy what percentage have GORD and PUD?
40% have GORD
13% havd PUD
What is dyspepsia?
A group of symptoms that alert doctors to consider disease of the upper GI tract
Dyspepsia itself is not a diagnosis
What are the symptoms of dyspepsia?
Upper abdominal pain or discomfort, heartburn, gastric reflux, nausea or voiting
What is GORD?
Gastro-oesophageal reflux disease
refers to endoscopically determines oesophagitis or endoscopy-negative reflux disease
What % of GORD and PUD sufferers self medicate?
50%
What percentage have cancer?
2% have gastric cancer
1% have oesophageal cancer
What are peptic ulcers?
Sores that develop in the lining of the stomach, lower oesophagus or small intestine
How much more frequent are duodenal ulcers than gastric ulcers?
10 times more frequent
What causes bleeding into the GI lumen?
damage to the blood vessels in tissues underlying the ulcer
What is a perforated ulcer?
When the ulcer penetrates the entire wall, resulting in leakage of the luminal content into the abdominal cavity
needs to be treated immediately - patient can die from infection
what % of patients with peptic ulcers suffer a perforation?
5-10%
this is higher in men than woman
What is the first sign of a perforated ulcer?
Sudden, intense, steady abdominal pain
How many patients die from perforated ulcer?
15%
Why do patients die from a perforated ulcer?
It enables the bacteria that live in your stomach to escape and infect the lining of the abdomen (peritoneum)
this is known as peritonitis
What happens in peritonitis?
the infection can rapidly spread in the blood (sepsis) before spreading to other organs
this carries the risk of organ failure and can be fatal if lest untreated
How does the mucosa protect the stomach from being digested?
The surface of the mucosa is lined with cells that secrete alkaline mucus that forms a thin layer over the luminal surface
both the protein content and its alkalinity neutralize H+ in the immediate area of the epithelium
What does the alkaline mucus form?
a chemical barrier between the highly acidic contents of the lumen and the cell surface
What do the tight junctions between epithelial cells do?
Limit the diffusion of H+ into the underlying tissue
How often are damaged epithelial cells replaced?
Every few days by new cells arising by the division of cells within gastric pits
What does peptic ulcer mean?
Ulcer of the stomach or duodenum
What does ulcer formation involve?
breaking down the mucosal barrier and exposing the uderlying tissue to the corrosive action of acid and pepsin
What are the characteristics of a peptic ulcer?
Epigastric pain that is relieved by antacids, nocturnal pain and vomiting
Who is peptic ulcer disease more common in?
Men and in smokers
there is often a family history of the disease
people who use NSAIDs or have a heavy alcohol intake