Peptic ulcer

Question 1

What is peptic ulcer disease

Answer 1

• Ulcers develop in lining stomach, lower oesophagus + duodenum (penetrates muscularis mucosae)
• Gastric + duodenal

Question 2

How common

Answer 2

• 1 in 10 (10% endoscopies reveal peptic ulcer)

Question 3

Who does it affect

Answer 3

• +60 years

Question 4

What are the causes of PUD

Answer 4

• H. pylori (95% duodenal + 80% gastric)
• -> inflammation lining + deplete protective alkaline mucous (alt pH)
• NSAIDs (inhibit prostaglandin = reduced prod alk mucus)
• Steroids

-Pepsin, Bile acids

Question 5

What are the risk factors

Answer 5

• smoking, alcohol, stress

Question 6

What are the symptoms

Answer 6

• Non-specific (Dx unreliable on Hx alone)
• Epigastric pain
• -> may wake pt at night, relieved by food
• -> can radiate to back (if post.)
• Nausea
• Oral flatulance, bloating, distension, intolerance of fatty food (also in gallstones)
• Symptoms relieved by antacids

Question 7

What are the signs on examination

Answer 7

• Epigastric tenderness

- (succession splash if gastric emptying slow –> sloshing sound w/ steth on sudden movement)

Question 8

What are the DDx

Answer 8

• AAA
• GORD
• malignancy
• Gallstones
• chronic pancreatitis
• IBS
• Acute ulcers (severe physiological stress e.g. burns/head injury)

Question 9

What are the investigations

Answer 9

• Test for H. pylori (carbon-13 urea test or stool antigen test)
• endoscopy (need +55yrs or red flags e.g. iron def anaemia, blood loss, weight loss, epigastric mass etc)

Question 10

What is the management/ treatment

Answer 10

• Modify behaviours e.g. cessation smoking, drugs stopped (change to H2RA + monitor)
• Antacids - short term pain relief
• H. PYLORI +VE = eradicate infection –> PPI, 2Abx (amoxicillin, clarithromycin, metronidazole)