Peptic Ulcer Disease Flashcards
What is dyspepsia?
A condition where digestion is impaired causing epigastric pain
List the symptoms associated with dyspepsia
- Epigastric pain
- Burning
- Fullness
- Bloating
- Satiety
- Nausea
- Sickness
- Heartburn
- Reflux
- Discomfort
What are the ALARM Symptoms
Anaemia
Loss of weight
Anorexia
Recent onset of symptoms
Melaena/ haematemesis
Swallowing difficulty
What is H. pylori infection?
Colonisation of gastric type mucosa
Evokes immune response causing gastritis
What is the pathogenesis of H. pylori infection?
Creates an enzyme called urease which increases the pH of the microenvironment
What is the outcome of antral predominant gastritis?
Increased acid
Low risk of gastric cancer
Duodenal ulcer (DU)
What is the outcome of corpus predominant gastritis?
Decreased acid
Gastric atrophy
Gastric cancer
What are the non-invasive diagnostic methods of H. pylori infection?
Serology
Urea breath test
Stool antigen test
What are the invasive diagnostic methods of H. pylori infection?
Endoscopy: tests on biopsy
- Histology
- Culture
- Rapid slide urease test (CLO test: urease will release CO2)
What are peptic ulcers?
A perforation or hole in the lining of the small intestine, lower oesophagus or stomach due to exposure to stomach acid
What are the majority of peptic ulcers caused by?
H. pylori infection
Which type of peptic ulcer is more common?
Duodenal ulcer is 4 fold commoner than GU
What are the risk factors for DU?
- H. pylori
- Drugs
- Increased gastric acid secretion
- Increased gastric emptying
- Smoking
What are the risk factors for GU?
- H. pylori
- Smoking
- NSAIDs
- Reflux of duodenal contents
- Delayed gastric emptying
- Stress
What are the symptoms of peptic ulcer?
- Epigastric pain
- Nocturnal/hunger pain (common in DU)
- Back pain
- Nausea occasionally vomiting
- Weight loss/anorexia
- Epigastric tenderness
- Haematemesis/melaena/anaemia
What are the treatment options for a peptic ulcer?
H. pylori eradication
Drugs to reduce acid: PPIs (omeprazole), H2 blockers (ranitidine)
Stop NSAIDs
What therapy is used for H. pylori eradication?
Triple therapy for 7-10 days
Effective in 90%
What are the complications of a peptic ulcer?
- Acute bleeding: melaena, haematemesis
- Chronic bleeding: iron deficiency anaemia
- Perforation
- Fibrotic stricture
- Gastric outlet obstruction: oedema or stricture
- Malignancy
What are the 3 types of gastritis?
- Autoimmune
- Bacterial
- Chemical injury
What is autoimmune gastritis?
Atrophy of specialised acid secreting gastric epithelium
Decreased acid secretion
Loss of intrinsic factor- Vitamin B12 deficiency
What is bacterial gastritis?
H. pylori infection of gastric mucus on surface epithelium
Produces inflammatory response
Increased acid production
What is chemical gastritis?
Caused by:
- Drugs
- Alcohol
- Bile reflux
