PEPTIC ULCER DISEASE Flashcards
……. Ulcer is more common
Duodenal
Which type of peptic ulcers occur more often in younger adults
Duodenal
Which type of gastric ulcers usually occur after middle age
Gastric
Which type of gastric ulcer is more oikely to be malignant
Gastric
Complications of peptic ulcers
Bleeding
Perforation
Gastric outlet obstruction
Causes of peptic ulcer
H. pylori
Excessive acid secretion
Inadequate protection of stomach and duodenum
Drug-induced
Drugs that can cause ulcers
NSAIDs
Corticosteroids
Symptoms of peptic upcer
Pain in epigastrium or right hypochondrium
Vomiting
Periumbilical pain in children
Nature of pain in gastric ulcer
Pain is worsened by food and may be relieved by vomiting
Nature of pain in duodenal ulcer
Pain is relieved by food and occurs when patient is hungry
Weight loss occurs in ….. ulcer
Gastric ulcer
Weight gain occurs in …. ulcer
Duodenal
Investigations in peptic ulcer disease
Hemoglobin
H. Pylori stool antigen
Endoscopy (esophago-gastro-duodenoscopy)
Barium meal in the absence of endoscopy
Stool examination to exclude intestinal parasites
Treatment objectives in peptic ulcer
To relieve pain and reduce gastric acid secretion
To eradicate H. pylori if present
To promote healing of the ulcer
To prevent recurrence of the ulcer
To prevent and manage complications
Non-pharmacological interventions for peptic ulcer
Reduce alcohol and tobacco intake
Avoid foods that aggravate pain
Reduce anxiety and stress
Surgical treatment
Pharmacological treatment for dyspepsia
1st line
Magnesium trisilicate 15ml 8 hourly
Or
Aluminium hydroxide 500mg 6 hourly
2nd Line
Omeprazole 20mg daily for 4 weeks
Avoid taking antacids within ……… of taking PPI
2 hours
Treatment for NSAID associated ulcer
Esomeprazole 20mg daily for 4 weeks
Or
Omeprazole 20mg daily for 4 weeks
Or
Pantoprazole 20-40mg daily for 4 weeks
Treatment for bleeding peptic ulcer
Esomeprazole IV
40mg daily
Or
Omeprazole IV
40mg 12 hourly for up to 15 days
How long should H pylori eradication therapy be given for
10-14 days
H. Pylori eradication regimen
Esomeprazole PO 20mg 12 hourly or Omeprazole 20mg 12 hourly or Pantoprazole 40mg 22 hourly
+ Amoxicillin 1g 12 hourly + Clarithromycin 500mg 12 hourly
Or
Esomeprazole PO 20mg 12 hourly or Omeprazole 20mg 12 hourly or Pantoprazole 40mg 22 hourly
+ Amoxicillin 1g 12 hourly + Clarithromycin 500mg 12 hourly
Or
Omeprazole 20mg 12 hourly + Amoxicillin 500mg 8 hourly + Metronidazole 400mg 8 hourly
