Peptic ulcer disease Flashcards
How do peptic ulcers form
Result from the corrosive action of acidic gastric juice on vulnerable epithelium
What are the causes of refractory ulcers
- Poor compliance
- Smoking
- NSAIDs
- Untreated H.Pylori
- Gastrinoma: Z.E.Syndrome
- Malignancy
What are the management of peptic ulcers
- Stop aggravating factors
- Multiple biopsies to exclude cancer
- Evaluate for compliance
- High doses of PPI can heal 90% of ulcers
- Surgery for those not responding
What is the management of bleeding ulcers
- Resuscitation
- PPI
- Endoscopic: -Thermocoagulation, Clipping artery, Injection of adrenaline
- Interventional Radiology (Embolisation)
- Surgery: Underrunning the bleeds
What is gastric outlet obstruction characterised by and diagnosed with
- Vomiting
- Weightloss
- Visible epigastric peristalsis
- Sucussion splash
- Typical electrolyte and metabolic abnormalities
Diagnosed with barium meal/endoscopy
What is the management of gastric outlet obstruction
- Decompress the stomach
- Correct the electrolytes
- TPN
- Endoscopic dilatation
- Surgery: Pyloroplasty, Anthrectomy
What are the complications of ulcer surgery
Early:
*Duodenal stump leakage: Common cause of death
*Gastric Retention: Could be oedema or narrow anastomosis
Late complications:
- Recurring ulcer: Stomal, Anastomotic, Marginal
Reasons: Insufficient operation ,inadequate gastric resection,
Incomplete vagotomy, Retained Anthrum, Z.E Syndrome.
- Dumping syndrome: palpitations, sweating, weakness, dyspnoea, flushing, nausea, pain, vomiting & diarrhoea
What is the management of an ulcer perforation
- Resucitate the patient
- Surgery: Omental patch
- Postoperatively: Eradicate H pylori, PPI treatment
What are the two types of stress ulcers caused by
Curling ulcers:
-Shock
-Sepsis
-Burns
Cushings ulcers
- Head trauma
- Tumours
