Peptic Ulcer Disease Flashcards
What is a peptic ulcer.
A break in the mucosal surface of >5mm.
What bacteria is associated with PUD.
Helicobacter pylori is associated with 90% of duodenal ulcers and 80% of gastric ulcers.
Where can peptic ulcer disease develop. (2)
Stomach.
Duodenum.
What percentage of duodenal ulcers are associated with H.pylori infection.
90%.
What percentage of gastric ulcers are associated with H.pylori infection.
80%.
What risk factors are associated with PUD. (4)
H.pylori infection.
Alcohol.
NSAIDs.
Smoking.
What are the symptoms of PUD. (2)
Heartburn.
Regurgitation.
What further tests are conducted in a patient presenting with PUD. (2)
OGD.
Testing for H.pylori.
Who does not need to undergo further tests if they present with symptoms of PUD.
What tests is given to patients
Urea breath test.
FBC.
What are the complications of PUD. (4)
GI bleed.
Perforation.
Malignancy.
Gastric outlet obstruction.
What is the treatment for PUD. (6)
Antacids. H2 receptor antagonists. Eradication of H.pylori. PPI. Sucralfate. Avoidance of smoking, NSAIDs and alcohol.
In patients with gastric ulcers, what should be carried out as follow up.
OGD to ensure healing of the ulcer.
Who undergoes further investigation if they present with typical symptoms of PUD. (2)
Anyone >55 years with new onset dyspepsia.
Anyone with alarm symptoms.
What are the ALARM Symptoms. (6)
Anaemia (iron deficiency). Loss of weight. Anorexia. Recent onset/progressive symtpoms. Melaena/haematemesis. Swallowing symptoms.
What is the epigastric pain of PUD usually related to. (6)
Hunger. Specific foods. Time of day. Bloating. Fullness after meals. Heartburn.
What is heartburn. (2)
Retrosternal pain and reflux.
What does the urea breath test detect.
The presence of H.pylori.
What kind of ulcer is more common.
Duodenal ulcers are 4 times more common than gastric ulcers.
What are the risk factors for duodenal ulcers. (7)
H. pylori infection. Drugs (NSAIDs, steroids, SSRI). Increased gastric acid secretion. Increased gastric emptying (decreased duodenal pH). Blood group O. Smoking. Stress? (debatable).
What are the symptoms of duodenal ulcers. (4)
Epigastric pain typically before meals or at night.
Relieved by eating or drinking milk.
50% are asymptomatic - others experience recurrent episodes.
What are the signs of duodenal ulcers.
Epigastric tenderness.
How are duodenal ulcers diagnosed. (2)
Upper GI endoscopy.
H pylori test.
What must be stopped 2 weeks before an upper GI endoscopy.
PPIs.
When must you measure gastrin concentrations when off of PPIs.
If you suspect Zollinger-Ellison syndrome.
What is the differential diagnosis for duodenal ulcers. (6)
Duodenal ulcer due to PUD. Non-ulcer dyspepsia. Duodenal Crohn's. TB. Lymphoma. Pancreatic cancer.
Is follow up necessary for duodenal ulcers.
Not necessary if the response to treatment is good.
Who is most at risk of developing gastric ulcers.
More common in the elderly.
What are the risk factors for gastric ulcers. (8)
H pylori infection (80%). Smoking. NSAIDs. Reflux of duodenal contents. Delayed gastric emptying. Stress. Curling's ulcers. Cushing's ulcers. Stress.
What are the symptoms of gastric ulcers. (4)
Asymptomatic.
Epigastric pain.
Pain related to meals and relieved by antacids.
Weight loss.
How do you diagnose gastric ulcers. (4)
Upper endoscopy to exclude malignancy.
Multiple biopsies from ulcer rim and base (histology, H.pylori).
Brushings (cytology).
Repeat endoscopy (eg if perforation or bleeding) to check healing.
What aspects are involved in the treatment of PUD. (4)
Lifestyle changes.
H. pylori eradication.
Drugs to reduce acid.
Drug-induced ulcer treatment.
What are the lifestyle changes in the treatment of PUD. (4)
Stress control.
Reduce alcohol.
Stop smoking.
Avoid aggravating foods.
How is H.pylori eradicated.
Triple therapy is effective in 80-85% of cases.
What drugs are used to reduce acid. (2)
PPIs (lansoprazole). H2 antagonists (ranitidine).
How do you treat drug induced ulcers. (2)
Stop drug if possible.
PPIs may be best for treating and preventing GI ulcers and bleeding in patients on NSAID or antiplatelet drugs.
What is the male:female ratio for duodenal ulcers.
Varies from 5:1 to 2:1.
What is the male:female ratio for gastric ulcers.
2:1.
What sort of bacteria is H. pylori.
Gram negative spiral.
What enzyme does H pylori produce.
Urease.
What is involved in triple therapy for H pylori eradication. (3)
A PPI taken with two antibiotics for 7 days.
What antibiotics are used in triple therapy. (3)
Any two from: amoxicillin, clarithromycin and metronidazole.
What are the indications for surgery in peptic ulcer disease. (5)
Emergency: perforation, haemorrhage.
Gastric outflow obstruction.
Persistant ulceration despite adequate medical therapy.
Recurrent ulcer following gastric surgery.
What is Zollinger-Ellison syndrome. (3)
A rare disorder characterised by the triad of:
Severe peptic ulceration.
Gastric acid hypersecretion.
non beta cell islet tumour of the pancreas (gastrinoma).
