Peptic Ulcer Disease

Question 1

Where can peptic ulcers be?

Answer 1

Gastric or duodenal (most common)

Question 2

What are the symptoms of peptic ulcers?

Answer 2

Pain

Haematemesis or melena

Pain 3 hours after eating

Anaemia

Question 3

What are the three main causes of peptic ulcers?

Answer 3

1. NSAIDS
2. Zollinger Ellinson Syndrome - Pancreatic tumour producing gastrin
3. H.pylori

Question 4

Why does H.pylori infection lead to peptic ulcers?

Answer 4

They colonise and increase the amount of gastrin from G cells and inhbit D cells

Question 5

How does H.Pylori survive in the stomach?

Answer 5

By using urease to convert urea to ammonia for survival

Question 6

What is the best test for H.Pylori?

Answer 6

Urea breath test. Drink radiolabelled Urea and then the Co2 expelled can be seen

Question 7

What is the 1st line treatment for an ulcer?

Answer 7

Advice, stop NSAIDS and meds

If there are red flags then endoscopy

Question 8

What is the 2nd line treatment for an ulcer?

Answer 8

H.Pylori test

If positive PPI and clarithromycin

If negative 8 weeks of PPI

Question 9

What are long term complications of PPIs?

Answer 9

Osteroporosis as calcium absorption inhibited

Question 10

What cancer is h pylori associatd with?

Answer 10

MALT lymphoma