Peptic Ulcer Disease

Question 1

what is peptic ulcer disease

Answer 1

infection of the mucosa of the stomach 20% and duodenum 80% causing ulcers

Question 2

what is the bacterial agent that causes PUD

Answer 2

helicobacter pylori

Question 3

where is this bacterial commonly found

Answer 3

the stomach

Question 4

how does the h.pylori live in the stomach

Answer 4

attaches to mucosa producing cells and releases adhesion molecules to assist with attachment
releases urease to neutralizes the gastric acids by breaking down urea into ammonia and c02 (ammonia is basic)

Question 5

Aetiology of PUD

Answer 5

bacterial H.pylori
idiopathic
inflammation
hypergastrinemia
- gastrin is a hormone that increases the secretion of hydrochloric acid

Question 6

Risk Factors

Answer 6

hydrochloric acid 
biliary acid
steroids/NSAIDS
chronic gastritis: inflammation of gut mucosa
smoking
alcohol
caffeine
stress

Question 7

Patho

Answer 7

tissue trauma (from bacteria etc) = inflammation = tissue damage
increase of gastrin to fight off bacteria = increase in acid secretion = tissue damage
defences are imparied

Question 8

what are our regular defences

Answer 8

regular secretion
intact perfusion
regeneration

Question 9

Manifestations

Answer 9

abdominal pain- burning, cramping

nausea, vomiting

Question 10

Complications

Answer 10

perfection of the ulcer = peritonitis
hemorrhage (damage to blood vessels by the acid)
gastric obstruction
- lumen edema, spasm, scar tissue contraction

Question 11

Diagnosis

Answer 11

History and physical exam
serology (test for Ab against h.pylori present)
Urea breath test: the c02 from the urea breakdown
fecal antigens (present in the stool)
Barium swallow (ingets - xray to see where/how many ulcers there are)
endoscopy

Question 12

Treatment

Answer 12

anatacids
TRIPLE REGIME
- h2ra +2 AB
- PPI + 2 AB
surgery for complications