Peptic ulcer & aspirin

Question 1

Peptic ulcer?

Answer 1

It is mucosal defect in the portion of gastrointestinal tract exposed to acid and pepsin secretion

Question 2

What increases the risk?

Answer 2

Infection with H pylori
Use of aspirin and NSAIDS
Minor factors: use of warfarin & corticosteroids

Question 3

Complications?

Answer 3

Penetration - gastro content erodes to adjacent organs like liver and pancreas
Perforation - gastro content enter the peritoneum, causing peritonitis
Hemorrhage - bleeding with vomiting and black faeces

Question 4

Pathophysio?

Answer 4

imbalance of aggresive and defensive factors

Question 5

Diagnosis

Answer 5

Not easy to differentiate PUD and gastriris based on symptoms.
Differentiate = endoscopy and contrast radiography
Diagnose H pylori= gastric mucosal biopsy culture, 13c urea breath test, ELIDA test on H pylori immunoglobulins

Question 6

Causes of gastritis & PUD

Answer 6

H pylori - it moves deep into the mucosal gel which coats the gastric mucosa and hence disrupt its function
NSAIDS, aspirin - inhibit mucosal enzyme, cyclooxygenase, hence reducing mucosal PGE, cannot produce mucus
Gastrinoma - gastrin secretion tumor, secretes gastrin till ulceration occurs
Alcohol
Severe Stress

Question 7

Symptoms of PUD

Answer 7

Pain in the upper abdomen
Pain usually occurs when stomach is empty
Gastric ulcer - sharp pain in the stomach after eating
Duodenal ulcer - pain relieved by eating
Nausea & vomiting (green/bloody)
Bloating
Severe = vomiting large amt of blood, rapid bleeding in stomach, feeling of faint

Question 8

Treatment of PUD

Answer 8

Endoscopy used to see the ulceration area and obtain a biopsy
Neutralize acid by antacid
Decrease acid production by using H2 receptor antagonist or proton pump inhibitor