PBL 1

Question 1

What is the main outcome of Low Vitamin B12?

Answer 1

Pernicious Anaemia as Vitamin B12 is involved in DNA synthesis, which is important in red blood cell production.

Question 2

What is a Peptic Ulcer?

Answer 2

A peptic ulcer is when there is a break in the superficial epithelial cells penetrating down to the muscularis mucosa of either the stomach or the duodenum; there is a fibrous base and an increase in inflammatory cells.

Question 3

Which is more common? Gastric or Duodenal Ulcers?

Answer 3

Duodenal Ulcers

Question 4

What are the two major aetiologic factors responsible for peptic ulceration?

Answer 4

H.Pylori and the use of NSAIDs. Duodenal Ulcers are almost always associated with H.Pylori and Gastric ulcers are almost always associated with NSAID use.

Question 5

What is Zollinger Ellison Syndrome?

Answer 5

It is a syndrome of gastric acid hypersecretion caused by a gastrin secreting neuro-endocrine tumour.

Question 6

How do NSAIDs cause injury?

Answer 6

Directly via a mechanism involving trapping hydrogen ions and indirectly via a systemic effect involving the inhibition of COX, particularly COX-1. They also increase bleeding risk due to the anti-platelet actions.

Question 7

Name the different diagnosing methods for Peptic Ulcers.

Answer 7

Serological tests detecting IgG
13C-Urea Breath Test
Stool Antigen Test
Endoscopy: Biopsy Urease Test
Histology
Culture

Question 8

How does the 13C-Urea Breath Test work?

Answer 8

H.Pylori convert urea to ammonia and CO2. 13CO2 is measured on the breath, after 13C-urea ingestion, using a mass spectrometer.

Question 9

How does the Biopsy Urease test work?

Answer 9

The gastric biopsy has urea and phenol red added to it.If H.Pylori are present they will convert urea to ammonia and CO2. The ammonia will cause an elevation in pH of the solution and a colour change will be observed in phenol red from yellow to red.