Peptic ulcer disease Flashcards
define peptic ulcer disease
Peptic ulcers are defects in the gastric or duodenal mucosa that extend through the muscularis mucosa
what can cause PUD
H-pylori (most common)
NSAIDs, corticosteroids
Stress, alcohol, caffeine, smoking and spicy foods, are all known to increase the stomachs production of acid
risk factors of PUD
Alcohol consumption
H-pylori Infection
Peak incidence occurring between 55 and 65 years of age
FHx of PUD
what is a rare cause of PUD which is identified by a fasting gastrin level of >1000 pg/ml
Zollinger-Ellison’s syndrome which is a gastrinoma, by increased gastric there is increased HCL release from parietal cells
triad of: severe peptic ulcer disease, gastric acid hypersecretion, and gastrinoma.
presentation of PUD
Epigastric pain can be worse after eating (gastric ulcer) or improves after eating (peptic ulcer).
N&V
If there is bleeding: haematemesis, coffee ground vomit, and melaena.
anaemia.
haemorrhage will present much more clinically unwell.
who does nice guidelines recommend an urgent ODG to
New-onset dysphagia
Aged >55 years with weight loss and either upper abdominal pain, reflux, or dyspepsia
New onset dyspepsia not responding to PPI treatment
what is triple therapy
10-14 days of PPI, 2 ABX - clarithromycin, amoxicillin
what is the management of PUD
suspected or confirmed ulcers can be started on a PPI for 4-8 weeks
reassessed after this period for resolution of symptoms
Persistence of symptoms post-PPI +/- eradication therapy warrants further work-up, with the first line being an urgent OGD to exclude any malignancy
how can you investigate suspected PUD
ODG with CLO test
NICE recommends all patients with identified ulcers have biopsy and that a repeat endoscopy is performed towards the end of PPI therapy
what are some complications of PUD
Haemorrhage
perforated ulcer
Pyloric stenosis
describe a perforated ulcer
peritonitis due to gastric contents
15% mortality rate.
most likely in elderly patients on chronic NSAID therapy, and are more common in gastric ulcers.
acutely unwell, may have left shoulder tip pain as well.
Erect CXR can be used to detect pneumoperitoneum to diagnose perforation
describe pyloric stenosis as a complication from PUD
chronic inflammation causes scarring and strictures, or oedema, which can obstruct the pyloric sphincter.
This presents with N+V, distention and reflux like symptoms, which are particularly present after meals.
which arteries are at risk of perforation from PUD
Gastric ulcers: left gastric artery
Duodenal ulcers: gastro-duodenal artery.
