Peptic Ulcer Disease

Question 1

What are the risk factors for developing peptic ulcer disease?

Answer 1

• H. pylori infection
• NSAID use
• Smoking
• ICU stay
• Increasing age
• Family history

Question 2

What are likely history and examination findings in a patient with peptic ulcer disease?

Answer 2

• Abdominal pain (often localised and epigastric)
• Nausea and vomiting, anorexia
• GI bleeding signs possible (and anaemic signs)

Question 3

What should be the investigative trail in a patient suspected to have peptic ulcer disease?

Answer 3

• H. pylori test
• Gastroscopy/biopsy
• Stool haem test (and FBC if positive)
• Fasting gastrin levels

Question 4

Outline the pathophysiology of the peptic ulcer disease

Answer 4

PUD results from an imbalance between

• Mucosal damage - acid, pepsin, H. pylori, NSAIDs
• GI defense - PGs, mucus, bicarbonate, mucosal blood flow

Question 5

What are the management principles of peptic ulcer disease?

Answer 5

• Treat complications
  
  • Repair of active bleeding
• Eliminate underlying cause
  
  • H. pylori positive - triple therapy (amoxy, PPI and clarithromycin)
• Relieve symptoms and heal ulcers
  
  • PPI and cause treatment