Peptic ulcer disease Flashcards
What are the risk factors for peptic ulcer disease?
Helicobacter pylori,
Drugs: NSAIDs, SSRIs, steroids, bisphophonates.
Zollinger-Ellison syndrome
Main two = H pylori and NSAIDs
What are the features of peptic ulcer disease?
Epigastric pain,
Nausea
Duodenal ulcers - more common, epigastric pain when hungry and relieved by eating.
Gastric ulcer - epigastric pain worsened by eating.
What are the investigations for uncomplicated peptic ulcer disease?
If > 55 with weight loss and dyspepsia then urgent OGD.
Urea breath test or stool antigen testing first line.
Definitive diagnosis is with endoscopy.
What is the treatment for uncomplicated peptic ulcers?
If H pylori positive - eradication therapy and if associated with NSAID use then 2 months of PPI.
If H pylori negative - give PPI until ulcer healed
What are the features of a perforated peptic ulcer?
Epigastric pain which later becomes generalised. May have syncope
What are the investigations for perforated peptic ulcer disease?
Clinical diagnosis and erect chest x ray (pneumoperitoneum).
Often needs laparoscopic repair
What are the differential diagnosis for peptic ulcer disease?
Gastritis, GORD, stomach cancer
What is recommended for gastric ulcer?
Repeat endoscopy 6-8 weeks after the start of PPI treatment to ensure ulcer is healing and there is no cancer
What is the presentation of a bleeding ulcer?
Melaena, hypotension and tachycardia. Bleeding often comes from gastroduodenal artery.
What is the management of a bleeding peptic ulcer?
A-E exam,
IV Proton pump inhibitors,
Transfusion if Hb < 70. Platelets if < 50.
Endoscopic intervention. If that fails then urgent interventional angiography with transarterial embolisation or surgery.
What are the risks associated with PPI?
Hyponatraemia,
Hypomagnasaemia,
Osteoporosis,
Miscroscopic colitis,
Increased risk of C. diff
What are some complications of peptic ulcers?
penetration into adjacent organ,
Gastric outlet obstruction due to strictures,
Upper GI bleed,
Perforation
