Peptic Ulcer* Flashcards
How is a peptic ulcer formed
There is a break in the mucosa of the stomach/duodenum typically greater than 5mm
What is the most common type of peptic ulcer
Duodenal ulcers are more common than gastric ulcers
What is the most common cause of peptic ulcers
H.Pylori infection (Esp Duodenal)
Inflammation breakdown the protective lining
What are the less common causes of peptic ulcers
NSAIDs Smoking and Alcohol Blood O Increased gastric secretion (Zollinger Ellison) Increased gastric emptying
Why can NSAIDs cause Peptic ulcers
They inhibit COX so decrease prostoglandin
They increase Acid production causing a decrease in mucus
What are some risk factors for Gastric ulcers
NSAID use
H.Pylori
Smoking
Zolllinger Ellison
How would you treat a H.Pylori peptic ulcer
CAP (2Abx with PPI)
- Clarithromycin
- Amoxicillin
- PPI (Lansoprazole)
How would you treat non H.Pylori Peptic ulcers
PPI with lifestyle change -Smoking cessation -Less alcohol -Regular small meals -Increase weight loss -Avoid NSAID and steroids Try antacids
How would you follow up a patient with a gastric ulcer
Repeat endoscopy 8 weeks after PPI
How would you follow up on duodenal ulcers
Check lifestyle modification
Rule out complications
Initiate low dose PPI
What are the signs of Peptic ulcers
Hypotension with Tachycardia
Melaena
Tender Abdomen
Pale (Anaemia)
What are the symptom of peptic ulcers
Burning epigastric pain Relief with food = Duodenal Worse with food = Gastric Haematemesis Dyspepsia Weight loss fatigue
How would you differentiate between duodenal and gastric ulcers
Duodenal = better with eating Gastric = worse with eating
What is the definitive management for a perforated peptic ulcer
Laparotomy
-Stabilise with IV Fluid first
How would you be able to determine if a peptic ulcer has perforated
There will be signs of peritonitis
Air will be seen on CT
How would you investigate Gastric ulcers
C Urea breath test
Stool Antigen test
Endoscopy w/ biopsy (Red flag)
How would you investigate Duodenal ulcers
Urea breath test
Stool antigen test
Endoscopy w/ biopsy (Red flag)
What can be seen on a duodenal biopsy in duodenal ulcer
Brunner’s Gland Hypertrophy
-Increased mucus production
When can Brunner’s Gland hypertrophy be seen
Duodenal biopsy
How are Peptic ulcers treated
Stop NSAID
Use CAP Therapy
-If PENICILLIN CI, Use Metronidazole
What is the difference in bleeding as a complication between gastric and duodenal ulcers
Gastric = Ruptured left gastric artery Duodenal = Ruptured Gastroduodenal artery
What is the Zollinger Ellison triad (Gastrin secreting tumour)
Pancreatic tumour
Gastric acid hyper secretion
Widespread Gastric ulcer
