Peptic Ulcer Flashcards
What is a peptic ulcer?
Ulceration of mucosa of stomach (gastric ulcer) or proximal duodenum (duodenal ulcer)
Duodenal ulcers are more common than gastric ulcers.
What is the pathophysiology of peptic ulcers?
Stomach mucous membrane secretes mucus + bicarbonate to protect it from the stomach contents; disruption in this barrier or increase in H+ increases mucosal ulceration, leading to damage down to the submucosa.
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What are the risk factors that disrupt the mucous barrier in peptic ulcers?
- Helicobacter Pylori - chronic infection
- NSAIDs
What factors can increase stomach acid and contribute to peptic ulcers?
- Stress
- Alcohol
- Caffeine
- Smoking
- Spicy foods
- Zollinger-Ellison syndrome
What medications increase the risk of bleeding from peptic ulcers?
- NSAIDs
- Aspirin
- Anticoagulants (DOACs)
- Steroids
- SSRI antidepressants
What are the non-specific symptoms of peptic ulcers?
- Reduced appetite
- Weight loss/gain
- Fatigue
- Epigastric discomfort/pain
- Nausea + vomiting
- Dyspepsia
What are the upper GI bleed symptoms associated with peptic ulcers?
- Haematemesis
- Coffee Ground vomit - digested/coagulated haematemesis
- Malaena (digested blood) + hypotension
- Fall in Hb (on FBC) - chronic microscopic bleeding leads to IDA with Low Hb, Low MCV, and low ferritin
What indicates a gastric ulcer compared to a duodenal ulcer?
Pain worse on eating + weight loss = gastric ulcer
Pain relieved by eating + weight gain = duodenal ulcer.
What is the gold standard for diagnosing peptic ulcers?
OGD Endoscopy
Not routine for non-bleeding but done in patients with dyspepsia + ALARMS. + stop PPIs for 1 week!!!
What tests are done if the patient is NOT actively bleeding?
- H.pylori breath test and/or stool antigen
- Endoscopy
- Fasting gastrin
What tests are performed if the patient IS actively bleeding?
- Bloods: FBC, U&Es, LFTs + coagulation profile
- Venous blood gas
- Upper GI endoscopy + biopsy
- Erect CXR
What is the first-line management for non-bleeding peptic ulcers?
- Conservative: treat risk factors e.g. stop NSAIDs
- H.pylori -ve: PPI high dose for 1 month
- H.pylori +ve: Triple eradication therapy (7 days): Omeprazole + Clarithromycin + Amoxicillin (Metronidazole if penicillin allergic)
What is the TRIPLE THERAPY if H.pylori +?
H.pylori +ve: Triple eradication therapy (7 days): Omeprazole + Clarithromycin + Amoxicillin (Metronidazole if penicillin allergic)
What is the follow-up procedure after treating non-bleeding peptic ulcers?
- H.pylori retest after 6-8 weeks with urea breath test
- Repeat endoscopy to ensure healing and screen for gastric cancer
What is the first-line management for bleeding peptic ulcers?
All patients have an Upper GI endoscopy within 24 hrs, with mechanical therapy, thermal coagulation, or sclerotherapy, plus high dose IV PPI after the scope.
What scoring systems are used in assessing bleeding ulcers?
- Glasgow Blatchford Score - for admission
- Rockhall Score - for re-bleeding risk after endoscopy
What are the complications of peptic ulcers?
- Bleeding
- Perforation + peritonitis
- Scarring and stricture leading to gastric outlet obstruction
