Lesson 3 Flashcards
List the diagnostic methods for peptic ulcer diseases
- Barium swallow
- Endoscopy
- Endoscopic biopsy
- Haemoglobin in blood
- Fecal occult blood test
Barium swallow
The patient will drink barium.
- Coats the upper GIT and provides contrast
- Allows us to better visualise the stomach and small intestine on X-rays
Endoscopy
A thin, lighted tube is introduced to the stomach and first part of the small intestine through the mouth
It is used to visualise ulcers, bleeding and any other tissue abnormalities
Endoscopic biopsy
Basically a guided biopsy allowing us to obtain a tissue sample to be analysed in the lab
Haemoglobin analysis
We analyse the presence of blood haemoglobin in the cases of anaemia which may be faced due to atrophic gastritis
Peptic ulcer protective factors
Mucous: has water, electrolytes and glycoproteins that cover and protect the mucosa from gastric acid secretions
Bicarbonate: Is able to penetrate the mucous, preventing the contact of the gastric mucosa with corrosive substances
Prostaglandins: promote the secretion of mucous and bicarbonate
High cell turnover: refers to the ability of gastric stem cells to repair and regenerate damaged tissue
High localised blood supply
Aggressive factors:
Helicobacter pylori and NSAIDs
Helicobacter pylori intro
- G(-), flagellated bacterium w/ a special tropism for gastric mucosa
- Person-person transmission: oral-oral or oral-fecal
- Able to survive in harsh surroundings (low pH)
- Produce ureases: generate NH3 that neutralise the HCl and damage epithelial cells
Helicobacter pylori significance in peptic ulcer disease
- Promotes chronic gastritis, and
- Up to 15% of infected individuals develop peptic ulcer
- Present in over 50 % of patients with peptic ulcer, and is considered the primary risk factor for its development
- Generates chemotactic factors for neutrophils and monocytes
that contribute to gastric mucosal lesion and ulcer development, - Can alter mucus and bicarbonate production and
increase hydrochloric acid levels.
H. Pylori eradication treatments, triple
- Clarithromycin + amoxicillin + PPI
- Clarithromycin + metronidazole + PPI
- Levofloxacin + amoxicillin + PPI
- Rifabutin + amoxicillin + PPI
H. Pylori eradication treatments, quadruple
Bismuth + metronidazole + tetracycline + PPI
H. Pylori eradication treatments, sequential
Amoxicillin + PPI for 5 days
followed by
Clarithromycin + metronidazole + PPI for 5 days
Diagnostic tests for H.pylori
Detection of antibodies in the blood to show that there has been an infection
Urea breath test
Detection of antigens in the stool supports diagnosis before and after treatment
Endoscopic biopsy of the gastric and duodenal lining for further analysis.
Aggressive factors, NSAIDs
- Widespread medication
It’s side effects involve gastric disturbances:
- Minor symptoms: Nausea and dyspepsia
- Serious complications: complicated or not
peptic ulcer
Can also produce mucosal damage directly due to their local
effects through their inhibition of prostaglandin production
Consequences:
- Decrease in epithelial secretion of mucus and bicarbonate
- Decreased mucosal blood flow, mucosal proliferation and impaired resistance to peptic
damage