Peptic Ulcer Disease Flashcards
What are the two main causes of peptic ulcers?
H.Pylori, NSAIDs (smoking too a much lesser extent)
Which gender is more likely to develop a peptic ulcer?
Males (especially older ones)
What percentage of cases of gastric and duodenal ulcers are a result of H.Pylori respectively?
70% of gastric (rest NSAIDs)
90% of duodenal (rest smoking)
How does H.Pylori cause ulceration in duodenum?
Forms ammonia from urea via urease raising the pH of the local area causing inhibition of somatostatin and hypergastrinaemia and increased acid secretion which damages duodenal mucosa
How does H.Pylori cause ulceration in the stomach?
Reduces the ability of the gastric mucosa to protect itself from acid and pepsin
How do NSAIDs cause ulceration?
The cox-1 pathway in traditional NSAIDs is inhibited and this prevents proper formation of mucous and bicarbonate secretion
What symptoms do duodenal and gastric ulcers have in common?
Epigastric discomfort, dyspepsia, temporary relief upon taking antacids
Chronic ulceration: weight loss, anorexia, anaemia
What must be excluded?
Malignancy
Symptoms of gastric vs duodenal
Pain increased by eating vs pain relieved by eating
Pain occurs between 30-60mins vs 2-3 hours
Less common vs more common
Vomiting occurs vs melena occurs
Investigations for duodenal include?
Do endoscopy and H.Pylori testing
How is H.Pylori testing done?
Breath test (highly sensitive and specific) required withholding PPIs 4 weeks previously
Serology (IgG good for differentiating current/past infections)
Biopsy
What tests are done for gastric ulcers?
Upper GI endoscopy to exclude malignancy and do H.Pylori testing
Management?
Stop NSAIDs, lifestyle changes,
If H.pylori negative? PPI inhibitors, H2 blockers
If positive? Eradicate
How is H.Pylori treated?
Triple therapy 2 times daily Full dose PPI Amoxicillin 1g Clarithromycin 500mg
Differentials for dyspepsia?
GORD, oesophagitis, non-ulcer dyspepsia, gastric malignancy, peptic ulcer, gastritis, duodenitis
What are the ALARM Signs for malignancy?
Anaemia, Loss of weight, Anorexia, Recent onset/progression, Melaena/haematemesis, Swallowing difficulty
Repeat endoscopy is done at 6 months to check healing as what complications can occur in peptic ulcer disease?
Bleeding and perforation
How is bleeding treated?
Fluid resus, acid suppression, inject ulcers with adrenaline, heat probe coagulation or clip placement.
If this all fails surgery will be required
What are the signs and treatment of perforation?
Abdo tenderness, guarding, rebound tenderness, erect CXR shows air under diaphragm
Give broad spectrum antibiotics and emergency surgery required
What is a peptic ulcer?
A break in the mucosa of the lower oesophagus, stomach or duodenum. Can be acute or chronic
If the peptic ulcer is particularly treatment resistant what must you consider?
Zollinger-Ellison syndrome (a rare adenoma that secretes gastrin causing peptic ulcers)
What surgery might be done for peptic ulcers?
Highly selective vagotomy (removes parasympathetic stimulation, reducing gastric acid secretion)