Peptic ulcer disease Flashcards
What is dyspepsia
Non specific symptoms related to upper GI
May relate to food, bloating, umbilical discomfort
Alarm symptoms with dyspepsia
Anaemia Loss of weight Anorexia Recent onset of progressive symptoms or hematemesis Swallowing difficulty
Signs to elicit
Tender epigastrium
Abdominal mass
Supraclavicular nodes
Managing new dyspepsia
FBC
FOBT
> 55 years or ALARM->Upper GI endoscopy
Stop drugs causing dyspepsia (NSAIDS, nitrates, anticholinergic, TCAs, CCB)
Lifestyle changes-> weight loss, smoking cessation, raise bed, small regular meals. Avoid hot drinks, spicy foods, alcohol, citrus, chocolate and eating test for H. pylori ->if +ve Eradication therapy and review in 4 weeks. If no improvement->UBT->if eradicated, do upper GI endoscopy
If initially -ve H pylori-> PPI for 4 weeks, if not improved will have longer dose and can consider upper GI endoscopy
What is more common gastric ulcers or duodenal ulcers
Duodenal
Major risk factors for duodenal ulcers
H pylori+++
NSAIDs, aspirin, steroids
Minor->+gastric acid, +gastric emptying, blood group O and smoking
Clinical presentation of duodenal ulcer
Epigastric pain before meals, at night
Relieved by eating or drinking milk
If doing an upper GI endoscopy, should PPIs be stopped
Yes, 2 weeks before
In what age group do gastric ulcers typically occur
Elderly
Risk factors for gastric ulcers
H pylori Smoking NSAIDs Reflux of duodenal contents Delayed gastric emptying Stress-->neurosurgery = Cushing's ulcer, or burns->curling's ulcer
Symptoms of gastric ulcer
May be asymptomatic
Epigastric pain related to meals, relieved with antacids +/= weight loss
What is done at upper GI endoscopy
Visualise
Multiple biopsies
Cytology
How long is PPI treatment for GU compared to DU
GU->8 weeks
DU->4 weeks
Differential diagnosis of dyspepsia
Non-ulcer dyspepsia OsophagitisGORD DU/GU Gastric malognancy Duodenitis Gastritis
Pathogenesis of GU related to NSAID use, intracranial, stress ulcers
NSAIDs-> -ve prostaglandins which normaly +mucin production and +vascular perfusion, therefore these are reduced
Intracranial->+activity of vagal nuclei= +gastric acid
Stress ulcers->splanchnic vasoconstriction
