Peptic Ulcer Disease

Question 1

What is PUD?

Answer 1

Ulceration of the mucosa of the stomach or duodenum

Question 2

Which type of ulcer is more common?

Answer 2

Duodenal ulcer

Question 3

Where does a duodenal ulcer usually develop?

Answer 3

First part of the duodenum

Question 4

Where does a gastric ulcer usually develop?

Answer 4

Lesser curvature and antrum

Question 5

How does PUD mainly present?

Answer 5

Asymptomatically

Question 6

What are possible symptoms of PUD?

Answer 6

Epigastric pain/discomfort
Dyspepsia
Nausea/vomiting
Iron deficiency anaemia

Question 7

What exacerbates the pain of a gastric ulcer?

Answer 7

Eating

Question 8

What relieves the pain of a duodenal ulcer?

Answer 8

Eating

Question 9

What is the main cause of PUD?

Answer 9

H. pylori infection

Question 10

What are the 2 mechanisms of injury resulting in PUD?

Answer 10

Breakdown of the protective layer of the stomach and duodenum
Increase in stomach acid

Question 11

What causes the breakdown of the protective layer of the stomach and duodenum?

Answer 11

H. Pylori
Drugs- Steroids, NSAID’s and SSRI’s

Question 12

What causes an increase in stomach acid?

Answer 12

Stress
Alcohol
Coffee
Smoking

Question 13

What is the main method of diagnosis of a an ulcer?

Answer 13

Endoscopy

Question 14

What would you do during an Endoscopy?

Answer 14

Rapid urease test for H. Pylori

Biopsy to check for malignancy

Question 15

What is the first line investigations to carry out to check for H. Pylori?

Answer 15

Urea breath test
Stool test

Question 16

What is the management of PUD if H. Pylori positive?

Answer 16

Triple therapy- Eradication therapy

(Amoxicillin, clarithromycin and a PPI twice daily for seven days)

Question 17

What does triple therapy include?

Answer 17

PPI and 2 antibiotics

Question 18

What drugs are used for triple therapy?

Answer 18

Omeprazole
Metronidazole
Clarithromycin/ Amoxicillin

Question 19

What are the possible complications of PUD?

Answer 19

Bleeding from ulcer
Perforation
Scarring and strictures

Question 20

What does acute bleeding from the ulcer cause?

Answer 20

Haemorrhage

Question 21

What does chronic bleeding from the ulcer cause?

Answer 21

Anaemia

Question 22

What does perforation lead to?

Answer 22

Peritonitis

Healing by fibrosis— Obstruction

Question 23

What drugs can cause peptic ulcer disease?

Answer 23

NSAID’s
SSRI’s
Steroids

Question 24

When should an endoscopy be repeated?

Answer 24

6-8 weeks after treatment has been started for gastric ulcer

Question 25

How can a perforated ulcer present?

Answer 25

severe upper abdominal pain of sudden onset.
PMH of peptic ulcer disease

Question 26

How can a perforated ulcer be diagnosed?

Answer 26

Erect chest x-ray

Question 27

What is the management of PUD if H.pyori negative?

Answer 27

PPI

Question 28

What might you find in a blood test of someone with PUD?

Answer 28

Iron deficiency anaemia due to chronic bleeding of ulcer

Question 29

What is the most common complication of PUD?

Answer 29

Bleeding

Question 30

What is the main source of the bleeding in peptic ulcer disease?

Answer 30

Gastroduodenal artery

Question 31

What symptoms would indicate a bleeding peptic ulcer?

Answer 31

haematemesis
melaena
hypotension, tachycardia

Question 32

What is the management of a bleeding peptic ulcer?

Answer 32

ABC
IV proton pump inhibitor
Endoscopic intervention

Question 33

How can a perforated peptic ucler be diagnosed?

Answer 33

Erect chest x-ray
(air under the diaphragm)