peptic ulcer Flashcards
what is a peptic ulcer
breach of the gi mucosa by acid/pepsin attack
aetiology
H pylori
NSAIDs
smoking etc
general symptoms
burning epigastric pain feeling of fullness and nausea dyspepsia inc acid production reflux symptoms
which type is relived by eating or milk
duodenal
when does gastric pain come on
1-2 hours after eating
when does duodenal pain come on
3-4 hours after, before meals or at night
melena seen in
duodneal ulcer
haematemesis seen in
gastric ulcer - relieved by vomiting
investigations
h pylori diganosis
how do we diagnose h pylori
stool antigen or C urea breath test
if H pylori is negative
endoscopy
what would you stop before endoscopy
PPI - 2 weeks before
complications
perforation penetration haemorrhage stenosis intractable pain
perforation
Causes acute abdomen with epigastric or generalised abdominal pain, tenderness, rebound tenderness and guarding that may progress to generalised rigidity.
treatment
antacids, H2 antagonists, PPI and h pylori eradication therapy
what if triple therapy doesnt work for h pylori
stop PPI for 2 weeks, retest
try metoclopramide or bismuth chelate
what are gastric ulcers relieved by
vomiting
what is bismuth chelate
a mucosal strengthener
what is metoclopramide
a pro kinetic anti emetic
what else is metoclopramide used in
gastroparesis and after MI
