Peptic Ulcer

Question 1

How do you tell the difference between a duodenal ulcer and a gastric ulcer clinically?

Answer 1

GU - made worse by eating (=wt loss)

DU - relieved by eating

Question 2

What is more common, a duodenal or a gastric ulcer?

Answer 2

Duodenal’s a 4x more common

most commonly in 1st part of duodenum

Question 3

What are the four main complications of a peptic ulcer?

Answer 3

Haemorrhage
Perforation
Gastric outflow obstruction (scarring + contraction)
Malignancy (H. Pylori increases risk)

Question 4

What blood tests would you run in suspected peptic ulcer disease?

Answer 4

FBC (anaemia)

U+E (urea rises in haemorrhage)

Question 5

What will be raised in Zollinger-Ellison syndrome?

Answer 5

Increased acid levels due to increased Gastrin production

Question 6

What is the definitive test for peptic ulcer disease

Answer 6

OGD

Stop PPI >2 weeks before test

biopsy all ulcers for malignancy

Question 7

What are the two ways of testing for H. Pylori

Answer 7

C13 breath test

Stool sample

Question 8

H. Pylori eradication is either done by the PAC500 regime, or the PMC250 regime, what do these stand for?

Answer 8

PAC500:
PPI, Amoxicillin 1g, Clarithromycin 500mg

PMC250
PPI, metronidazole 400mg, Clarithromycin 250mg

Question 9

What bloods would you run in a suspected perforated peptic ulcer? (7) And what other bedside test?

Answer 9

FBC, U+E, amylase, CRP, G+S, clotting, ABG (?mesenteric ischaemia)
Urine dip

Question 10

What is the name of the sign of bowel perf seen on AXR?

Answer 10

Rigler’s sign: air on both sides of the bowel

Question 11

5 steps of management in peptic ulcer perf?

Answer 11

NBM
Aggressive fluid resus (+catheter)
Analgesia (morphine + cyclizine)
ABx (cef+met)
NGT

Question 12

What percentage of peptic ulcer perforations are associated with H.Pylori?

Answer 12

90%