Peptic Ulcer Flashcards
1
Q
what is it?
A
break in mucosal surface > 5mm in either duodenum or stomach
2
Q
pathophysiology?
A
stomach mucosa is prone to ulceration from:
- breakdown of protective layer of stomach or duodenum (medications and H.Pylori)
- increase in stomach acid (alcohol, smoking, spicy foods etc)
3
Q
aetiology?
A
- H.Pylori
- Drugs: NSAIDs, steroids
- Alcohol
- Smoking
4
Q
what % duodenal and gastric ulcers is H.Pylori associated with
A
duodenal- 90%
gastric- 80%
5
Q
epidemiology?
A
M>F
6
Q
symptoms of both gastric and duodenal ulcers?
A
Dyspepsia
Gastric:
- epigastric discomfort / pain
- worse on eating
- relieved by antacids
Duodenal:
- epigastric discomfort/pain
- relieved by eating or milk
- worse before meals and at night
7
Q
signs?
A
- may be epigastric tenderness
- nausea / occasionally vomiting / wt loss
8
Q
Ix?
A
- H.pylori urea breath test / stool antigen test
- OGD
- stop PPIs 2 weeks before
- ALWAYS take biopsies of ulcers
- Bloods (FBC, urea)
9
Q
Mx?
A
- conservative (lose weight, stop smoking, cut down alcohol)
- medical
- antacids
- H2RA/PPI
- H.Pylori eradication therapy
- surgical (no acid= no ulcer)
- vagotomy
- subtotal gastrectomy w Roux-en-Y
10
Q
Complications?
A
- gastroduodenal bleeding from ulcer
-
perforation
- –> peritonitis –> acute abdo
- obstruction due to healing by fibrosis
- malignancy –> increased risk w H.Pylori
11
Q
what is H.Pylori eradication therapy?
A
- triple therapy for 7 days
- clarithromycin 500mg BD
- Amoxicillin 1g BD OR Metronidazole
- PPI
12
Q
what is it? and how does it work?
A
- gram negative aerobic bacteria
- works by damaging epithelial lining of stomach & produces ammonia which neutralises stomach acid and causes rise in pH
13
Q
what are the tests you can do for H.Pylori?
A
- urea breath test
- stool antigen test
- rapid urease test
- can be performed during endoscopy
