Peptic Ulcer Disease Flashcards
Peptic Ulcer Disease is an umbrella term and refers to which types of ulcers
Duodenal and gastric
Which ulcer is the pain worsened by eating
Gastric ulcers
Which ulcer is the pain improves by eating
Duodenal ulcers
What is the main risk factor for peptic ulcer disease
Helicobacter pylori infection.
Helicobacter pylori infection is the main risk factor for peptic ulcer disease.
Name other risk factors
NSAID use
smoking
foods and drink that increase acid production e.g. acidic foods, coffee, fatty or spicy foods
What is the gold standard imaging investigation for peptic ulcer disease
Upper GI endoscopy
Name the two gold standard investigations for peptic ulcer disease
Upper GI endoscopy
testing for H Pylori infection by urea breath test or stool antigen test
What are the 3 classic features of peptic ulcer disease
dyspepsia - indigestion
abdominal discomfort
nausea
What is an ulcer
a deep break through the full thickness of the epithelium or mucosal surface
What are the most commonly identified aetiological factors of peptic ulcer disease
H. pylori infection and history of NSAID use
Which is the most common
a) Gastric ulcer
b) Duodenal ulcer
b) Duodenal ulcer
Epigastric pain worsened by eating is a feature of :
a) Gastric ulcer
b) Duodenal ulcer
a) Gastric ulcer
Epigastric pain relieved by eating is a feature of :
a) Gastric ulcer
b) Duodenal ulcer
b) Duodenal ulcer
Epigastric pain wrosened when hungry is a feature of :
a) Gastric ulcer
b) Duodenal ulcer
b) Duodenal ulcer
Weight loss is a feature of :
a) Gastric ulcer
b) Duodenal ulcer
a) Gastric ulcer
Weight gain is a feature of :
a) Gastric ulcer
b) Duodenal ulcer
b) Duodenal ulcer
Haematemesis is a feature of :
a) Gastric ulcer
b) Duodenal ulcer
a) Gastric ulcer
Melaena and coffee ground vomitus is a feature of :
a) Gastric ulcer
b) Duodenal ulcer
b) Duodenal ulcer
Which peptic ulcer disease is associated with an increased risk of carcinoma
a) Gastric ulcer
b) Duodenal ulcer
a) Gastric ulcer
Which peptic ulcer disease is aggravated immediately after food
a) Gastric ulcer
b) Duodenal ulcer
a) Gastric ulcer
Which peptic ulcer disease is aggravated when thte stomach is empty (1-2 hours after a meal)
a) Gastric ulcer
b) Duodenal ulcer
b) Duodenal ulcer
What aggrevates duodenal ulcers
When the stomach is empty (1-2 hours after a meal)
Which peptic ulcer disease is alleviated by vomiting or alkali food
a) Gastric ulcer
b) Duodenal ulcer
a) Gastric ulcer
Which peptic ulcer disease is alleviated by food intake
a) Gastric ulcer
b) Duodenal ulcer
b) Duodenal ulcer
What two mechanism make the gastric mucosa prone to ulceration
- Breakdown of the protective layer of the stomach and duodenum
- Increase in stomach acid
Breakdown of the protective barrier of the stomach and duodenum can cause peptic ulcer disease.
What two factors can breakdown the protective barrier
o Medications e.g. steroids or NSAIDs
o Helicobacter pylori (H.Pylori)
Increase in stomach acid can cause peptic ulcer disease.
Name some of the causes of the increase in stomach acid
Stress
Alcohol
Caffeine
Smoking
Spicy foods
What is the main risk factor of peptic ulcer disease
Helicobacter pylori infection
What is the second most common risk factor of peptic ulcer disease
NSAID use
Name some of the risk factors of peptic ulcer disease
- Helicobacter pylori infection - most common cause
- NSAID use - 2nd most common cause
- Other medications e.g. SSRIs, chronic steroid use, bisphosphonates
- Smoking
- Severe stress
- Zollinger-Ellison syndrome: rare cause characterised by excessive levels of gastrin, usually from a gastrin secreting tumour
- Gastric emptying
Increase in gastric emptying is a risk factor for which type of peptic ulcer disease
Duodenal ulcers
Increased gastric emptying for duodenal ulcers as there is more acid in the duodenum
Delayed in gastric emptying is a risk factor for which type of peptic ulcer disease
Gastric ulcers
Delayed gastric emptying for gastric ulcers as there is an increase length of time the stomach is exposed to the acid
What is the gold standard investigation for peptic ulcer disease
Upper GI endoscopy
What test can be performed during endoscopy for investigating peptic ulcer disease
A rapid urease test can be performed to check for H. pylori
What three investigations can be done to test for H.Pylori infection, as part of the workup of peptic ulcer disease
- Rapid urease test - done only using endoscopy
- Urea breath test
- Stool antigen test
Eradication therapy should be commenced in patients that are Helicobacter pylori positive.
Describe the eradication therapy for H pyolori
Eradication therapy is a triple-therapy that comprises: PPI and 2 antibiotics
Typically a 7-day course of oral PPI plus amoxicillin and either clarithromycin or metronidazole
If penicillin allergic, oral PPI plus clarithromycin and metronidazole
What is the management of peptic ulcer disease that are H.Pylori negative
4-8 weeks of full dose PPI treatment and lifestyle advice, including:
- Have more regular, smaller meals and eat 4 hours before bed
- Smoking cessation
- Avoid foods and drinks that increase stomach acid e.g. acidic foods, coffee, fatty or spicy foods
- Weight loss
- Stop causative medications e.g. NSAIDs, steroids, bisphosphonates, potassium supplements, SSRIs and crack cocaine
By what mechanism are NSAIDs responsible for causing gastric ulceration?
Inhibition of prostagladin secretion
Zollinger-Ellison syndrome is most commonly associated with which condition?
Multiple Endocrine Neoplasia syndrome
