Peptic Ulcer*

Question 1

How is a peptic ulcer formed

Answer 1

There is a break in the mucosa of the stomach/duodenum typically greater than 5mm

Question 2

What is the most common type of peptic ulcer

Answer 2

Duodenal ulcers are more common than gastric ulcers

Question 3

What is the most common cause of peptic ulcers

Answer 3

H.Pylori infection (Esp Duodenal)

Inflammation breakdown the protective lining

Question 4

What are the less common causes of peptic ulcers

Answer 4

NSAIDs
Smoking and Alcohol
Blood O
Increased gastric secretion (Zollinger Ellison)
Increased gastric emptying

Question 5

Why can NSAIDs cause Peptic ulcers

Answer 5

They inhibit COX so decrease prostoglandin

They increase Acid production causing a decrease in mucus

Question 6

What are some risk factors for Gastric ulcers

Answer 6

NSAID use
H.Pylori
Smoking
Zolllinger Ellison

Question 7

How would you treat a H.Pylori peptic ulcer

Answer 7

CAP (2Abx with PPI)

• Clarithromycin
• Amoxicillin
• PPI (Lansoprazole)

Question 8

How would you treat non H.Pylori Peptic ulcers

Answer 8

PPI with lifestyle change
-Smoking cessation
-Less alcohol
-Regular small meals
-Increase weight loss
-Avoid NSAID and steroids
Try antacids

Question 9

How would you follow up a patient with a gastric ulcer

Answer 9

Repeat endoscopy 8 weeks after PPI

Question 10

How would you follow up on duodenal ulcers

Answer 10

Check lifestyle modification
Rule out complications
Initiate low dose PPI

Question 11

What are the signs of Peptic ulcers

Answer 11

Hypotension with Tachycardia
Melaena
Tender Abdomen
Pale (Anaemia)

Question 12

What are the symptom of peptic ulcers

Answer 12

Burning epigastric pain
Relief with food = Duodenal
Worse with food = Gastric
Haematemesis
Dyspepsia
Weight loss
fatigue

Question 13

How would you differentiate between duodenal and gastric ulcers

Answer 13

Duodenal = better with eating
Gastric = worse with eating

Question 14

What is the definitive management for a perforated peptic ulcer

Answer 14

Laparotomy

-Stabilise with IV Fluid first

Question 15

How would you be able to determine if a peptic ulcer has perforated

Answer 15

There will be signs of peritonitis

Air will be seen on CT

Question 16

How would you investigate Gastric ulcers

Answer 16

C Urea breath test
Stool Antigen test
Endoscopy w/ biopsy (Red flag)

Question 17

How would you investigate Duodenal ulcers

Answer 17

Urea breath test
Stool antigen test
Endoscopy w/ biopsy (Red flag)

Question 18

What can be seen on a duodenal biopsy in duodenal ulcer

Answer 18

Brunner’s Gland Hypertrophy

-Increased mucus production

Question 19

When can Brunner’s Gland hypertrophy be seen

Answer 19

Duodenal biopsy

Question 20

How are Peptic ulcers treated

Answer 20

Stop NSAID
Use CAP Therapy
-If PENICILLIN CI, Use Metronidazole

Question 21

What is the difference in bleeding as a complication between gastric and duodenal ulcers

Answer 21

Gastric = Ruptured left gastric artery
Duodenal = Ruptured Gastroduodenal artery

Question 22

What is the Zollinger Ellison triad (Gastrin secreting tumour)

Answer 22

Pancreatic tumour
Gastric acid hyper secretion
Widespread Gastric ulcer