Peptic Ulcer Disease

Question 1

Where is the common site of PUD?

Answer 1

D1 and antrum

Squamocolumnar junction of oesophagus and stomach

Question 2

What is a chronic peptic ulcer?

Answer 2

Ulceration extending beyond the muscularis mucosae, destroying all layers through muscularis propria to subserosa

Question 3

What are the 4 layers of the chronic peptic ulcer floor?

Answer 3

Exudate of fibrin, neutrophils and necrotic debris
Narrow zone of fibrinoid necrosis
Zone of cellular granulation tissue
Zone of fibrosis including endarteritis and hypertrophied nerves

Question 4

What are the 4 possible complications of PUD?

Answer 4

Perforation of anteriorly located ulcers leading to peritonitis
Haemorrhage due to erosion of artery
Penetration (erosion into adjacent organ to cause fistula)
Stenosis due to contraction of fibrous scar around sphincters

Question 5

How can a peptic ulcer be distinguished from a gastric adenocarcinoma macroscopically?

Answer 5

Peptic ulcer has gastric folds up to the margins

Gastric adenocarcinoma does not, and may be fungating

Question 6

What are the 6 classes of drugs used to treat PUD?

Answer 6

PPIs
H2-receptor antagonists
Antacids
Cytoprotective agents
Spasmolytics (muscarinic receptor antagonist)
PGE2 analogues

Question 7

Cimetidine

Answer 7

H2-receptor antagonist

Question 8

Ranitidine

Answer 8

H2-receptor antagonist

Question 9

Omeprazole

Answer 9

PPI

Question 10

Esomeprazole

Answer 10

PPI

Question 11

NaHCO3-

Answer 11

Antacid

Question 12

Magnesium hydroxide

Answer 12

Antacid

Question 13

Sucralfate

Answer 13

Cytoprotective agent

Question 14

Hyoscine butylbromide

Answer 14

Spasmolytic (muscarinic receptor antagonist)

Question 15

Misoprostol

Answer 15

PGE2 analogue

Question 16

What is the triple therapy used to treat H. pylori infection?

Answer 16

Omeprazole
Clarithromycin
Amoxicillin