Peptic ulcer Flashcards
Definition
An ulcer in an area where the mucosa is exposed to HCl and Pepsin
Where are the main sites of peptic ulcers?
Stomach (gastric ulcers)
Duodenum (duodenal ulcers)
Cause
Chronic infection with H. Pylori
NSAIDs
H. Pylori
Burrows deep into mucous layer and secretes agents which cause persistent inflammation.
Mucosal barrier weakens
Submucosa (and deeper layers) are subject to attack by HCl and pepsin
Mainly occurs in the duodenum
NSAIDs
Weaken mucosal barrier leading to ulceration
Duodenal ulcer: Clinical presentation
Epigastric pain Pain can radiate to back Wakes patient up at night Aggravated by hunger Relieved by eating Relieved by drinking milk Nausea and vomiting Acute bleeding: haematemesis, malena
Gastric ulcer: Clinical presentation
Epigastric pain Pain can radiate to back Wakes patient up at night Aggravated by eating Nausea and vomiting Acute bleeding: haematemesis, malena
Histology
Punched out lesions
Well defined
Layered appearance
Investigations
Endoscopy
Biopsy - if gastric ulcer (to check for malignancy)
Barium contrast AXR
Diagnosing H. Pylori infection
Serology (antibodies)
Urease breath test (stop PPI 2 before doing this)
FAT (faecal antigen test)
Management aims
Reduce acid secretion
Increase mucosal resistance
Eradicate H. Pylori (if this is the cause)
Management - general
PPI
H2RA
H. Pylori eradication therapy
PPI + clarithromycin + amoxicillin OR
PPI + clarithromycin + metronidazole
RETEST: must stop PPI 2 weeks before this
Complications
Perforation
Haemorrhage
Emergency management of bleeding peptic ulcer
Endoscopy
Adrenaline injection (1:10,000) - vasoconstrics vessels
Heater probe coagulation - fry vessel, stop bleeding
Clips - close vessel
Haemospray - mechanical barrier
