Peptic Ulcer Disease

Question 1

What is PUD?

Answer 1

Full thickness ulcerations of duodenal / gastric mucosa.

Question 2

How do PUD ulcers form?

Answer 2

When exposure to acid + digestive enzymes overcomes mucosal defense mechanisms

Question 3

What are the risk factors for PUD? (4 things)

Answer 3

1. H pylori
2. NSAIDs
3. SSRIs
4. Corticosteroids

Question 4

What is stomach mucosa prone to ulceration from? (2 things)

Answer 4

1. Breakdown of protective layer of stomach + duodenum

2. Increase in stomach acid

Question 5

What is the protective layer of the stomach comprised of? (2 things)

Answer 5

1. Mucus

2. Bicarbonate

Question 6

What can the protective layer of the stomach be broken down by? (2 things)

Answer 6

1. Medications (e.g steroids / NSAIDs)

2. Helicobacter pylori

Question 7

What can an increase in stomach acid be caused by? (5 things)

Answer 7

1. Smoking
2. Stress
3. Caffeine
4. Alcohol
5. Spicy foods

Question 8

What are the CF of PUD? (5 things)

Answer 8

1. Epigastric discomfort / pain
2. Nausea + vomiting
3. Dyspepsia
4. Bleeding –> haematemesis + coffee ground vomiting + melaena
5. Iron deficiency anaemia (bc constant bleeding)

Question 9

What does eating do to the epigastric pain of gastric VS duodenal ulcers?

Answer 9

Gastric ulcers = eating worsens pain

Duodenal ulcers = eating relieves pain (pain when hungry)

Question 10

What is the best diagnostic test for PUD?

Answer 10

OGD endoscopy

Question 11

What should be done during endoscopy for sus PUD? (2 things)

Answer 11

1. Rapid urease test to check for H pylori

2. Biopsy (to exclude cancer)

Question 12

What is the management in H pylori NEGATIVE PUD?

Answer 12

PPI

Question 13

What is the management in H pylori POSITIVE PUD?

Answer 13

Eradication therapy

Triple therapy of PPI + 2 abx including amoxicillin

Question 14

What are the complications of PUD? (2 things)

Answer 14

1. Perforation

2. Bleeding