Peptic Ulcer Disease Flashcards
What is PUD?
Ulceration of the mucosa of the stomach or duodenum
Which type of ulcer is more common?
Duodenal ulcer
Where does a duodenal ulcer usually develop?
First part of the duodenum
Where does a gastric ulcer usually develop?
Lesser curvature and antrum
How does PUD mainly present?
Asymptomatically
What are possible symptoms of PUD?
Epigastric pain/discomfort
Dyspepsia
Nausea/vomiting
Iron deficiency anaemia
What exacerbates the pain of a gastric ulcer?
Eating
What relieves the pain of a duodenal ulcer?
Eating
What is the main cause of PUD?
H. pylori infection
What are the 2 mechanisms of injury resulting in PUD?
Breakdown of the protective layer of the stomach and duodenum
Increase in stomach acid
What causes the breakdown of the protective layer of the stomach and duodenum?
H. Pylori
Drugs- Steroids, NSAID’s and SSRI’s
What causes an increase in stomach acid?
Stress
Alcohol
Coffee
Smoking
What is the main method of diagnosis of a an ulcer?
Endoscopy
What would you do during an Endoscopy?
Rapid urease test for H. Pylori
Biopsy to check for malignancy
What is the first line investigations to carry out to check for H. Pylori?
Urea breath test
Stool test
What is the management of PUD if H. Pylori positive?
Triple therapy- Eradication therapy
(Amoxicillin, clarithromycin and a PPI twice daily for seven days)
What does triple therapy include?
PPI and 2 antibiotics
What drugs are used for triple therapy?
Omeprazole
Metronidazole
Clarithromycin/ Amoxicillin
What are the possible complications of PUD?
Bleeding from ulcer
Perforation
Scarring and strictures
What does acute bleeding from the ulcer cause?
Haemorrhage
What does chronic bleeding from the ulcer cause?
Anaemia
What does perforation lead to?
Peritonitis
Healing by fibrosis— Obstruction
What drugs can cause peptic ulcer disease?
NSAID’s
SSRI’s
Steroids
When should an endoscopy be repeated?
6-8 weeks after treatment has been started for gastric ulcer
How can a perforated ulcer present?
severe upper abdominal pain of sudden onset.
PMH of peptic ulcer disease
How can a perforated ulcer be diagnosed?
Erect chest x-ray
What is the management of PUD if H.pyori negative?
PPI
What might you find in a blood test of someone with PUD?
Iron deficiency anaemia due to chronic bleeding of ulcer
What is the most common complication of PUD?
Bleeding
What is the main source of the bleeding in peptic ulcer disease?
Gastroduodenal artery
What symptoms would indicate a bleeding peptic ulcer?
haematemesis
melaena
hypotension, tachycardia
What is the management of a bleeding peptic ulcer?
ABC
IV proton pump inhibitor
Endoscopic intervention
How can a perforated peptic ucler be diagnosed?
Erect chest x-ray
(air under the diaphragm)
