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Gastrointestinal > Peptic Ulcer Disease > Flashcards

Peptic Ulcer Disease Flashcards

1
Q

What is a peptic ulcer.

A

A break in the mucosal surface of >5mm.

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2
Q

What bacteria is associated with PUD.

A

Helicobacter pylori is associated with 90% of duodenal ulcers and 80% of gastric ulcers.

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3
Q

Where can peptic ulcer disease develop. (2)

A

Stomach.

Duodenum.

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4
Q

What percentage of duodenal ulcers are associated with H.pylori infection.

A

90%.

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5
Q

What percentage of gastric ulcers are associated with H.pylori infection.

A

80%.

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6
Q

What risk factors are associated with PUD. (4)

A

H.pylori infection.
Alcohol.
NSAIDs.
Smoking.

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7
Q

What are the symptoms of PUD. (2)

A

Heartburn.

Regurgitation.

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8
Q

What further tests are conducted in a patient presenting with PUD. (2)

A

OGD.

Testing for H.pylori.

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9
Q

Who does not need to undergo further tests if they present with symptoms of PUD.

A
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10
Q

What tests is given to patients

A

Urea breath test.

FBC.

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11
Q

What are the complications of PUD. (4)

A

GI bleed.
Perforation.
Malignancy.
Gastric outlet obstruction.

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12
Q

What is the treatment for PUD. (6)

A 
Antacids. 
H2 receptor antagonists. 
Eradication of H.pylori. 
PPI. 
Sucralfate.
Avoidance of smoking, NSAIDs and alcohol.
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13
Q

In patients with gastric ulcers, what should be carried out as follow up.

A

OGD to ensure healing of the ulcer.

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14
Q

Who undergoes further investigation if they present with typical symptoms of PUD. (2)

A

Anyone >55 years with new onset dyspepsia.

Anyone with alarm symptoms.

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15
Q

What are the ALARM Symptoms. (6)

A 
Anaemia (iron deficiency). 
Loss of weight. 
Anorexia. 
Recent onset/progressive symtpoms. 
Melaena/haematemesis. 
Swallowing symptoms.
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16
Q

What is the epigastric pain of PUD usually related to. (6)

A 
Hunger. 
Specific foods. 
Time of day. 
Bloating. 
Fullness after meals. 
Heartburn.
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17
Q

What is heartburn. (2)

A

Retrosternal pain and reflux.

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18
Q

What does the urea breath test detect.

A

The presence of H.pylori.

19
Q

What kind of ulcer is more common.

A

Duodenal ulcers are 4 times more common than gastric ulcers.

20
Q

What are the risk factors for duodenal ulcers. (7)

A 
H. pylori infection. 
Drugs (NSAIDs, steroids, SSRI). 
Increased gastric acid secretion. 
Increased gastric emptying (decreased duodenal pH). 
Blood group O. 
Smoking. 
Stress? (debatable).
21
Q

What are the symptoms of duodenal ulcers. (4)

A

Epigastric pain typically before meals or at night.
Relieved by eating or drinking milk.
50% are asymptomatic - others experience recurrent episodes.

22
Q

What are the signs of duodenal ulcers.

A

Epigastric tenderness.

23
Q

How are duodenal ulcers diagnosed. (2)

A

Upper GI endoscopy.

H pylori test.

24
Q

What must be stopped 2 weeks before an upper GI endoscopy.

A

PPIs.

25
Q

When must you measure gastrin concentrations when off of PPIs.

A

If you suspect Zollinger-Ellison syndrome.

26
Q

What is the differential diagnosis for duodenal ulcers. (6)

A 
Duodenal ulcer due to PUD.
Non-ulcer dyspepsia. 
Duodenal Crohn's. 
TB. 
Lymphoma. 
Pancreatic cancer.
27
Q

Is follow up necessary for duodenal ulcers.

A

Not necessary if the response to treatment is good.

28
Q

Who is most at risk of developing gastric ulcers.

A

More common in the elderly.

29
Q

What are the risk factors for gastric ulcers. (8)

A 
H pylori infection (80%). 
Smoking. 
NSAIDs. 
Reflux of duodenal contents. 
Delayed gastric emptying. 
Stress. 
Curling's ulcers. 
Cushing's ulcers. 
Stress.
30
Q

What are the symptoms of gastric ulcers. (4)

A

Asymptomatic.
Epigastric pain.
Pain related to meals and relieved by antacids.
Weight loss.

31
Q

How do you diagnose gastric ulcers. (4)

A

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.

32
Q

What aspects are involved in the treatment of PUD. (4)

A

Lifestyle changes.
H. pylori eradication.
Drugs to reduce acid.
Drug-induced ulcer treatment.

33
Q

What are the lifestyle changes in the treatment of PUD. (4)

A

Stress control.
Reduce alcohol.
Stop smoking.
Avoid aggravating foods.

34
Q

How is H.pylori eradicated.

A

Triple therapy is effective in 80-85% of cases.

35
Q

What drugs are used to reduce acid. (2)

A 
PPIs (lansoprazole). 
H2 antagonists (ranitidine).
36
Q

How do you treat drug induced ulcers. (2)

A

Stop drug if possible.

PPIs may be best for treating and preventing GI ulcers and bleeding in patients on NSAID or antiplatelet drugs.

37
Q

What is the male:female ratio for duodenal ulcers.

A

Varies from 5:1 to 2:1.

38
Q

What is the male:female ratio for gastric ulcers.

A

2:1.

39
Q

What sort of bacteria is H. pylori.

A

Gram negative spiral.

40
Q

What enzyme does H pylori produce.

A

Urease.

41
Q

What is involved in triple therapy for H pylori eradication. (3)

A

A PPI taken with two antibiotics for 7 days.

42
Q

What antibiotics are used in triple therapy. (3)

A

Any two from: amoxicillin, clarithromycin and metronidazole.

43
Q

What are the indications for surgery in peptic ulcer disease. (5)

A

Emergency: perforation, haemorrhage.
Gastric outflow obstruction.
Persistant ulceration despite adequate medical therapy.
Recurrent ulcer following gastric surgery.

44
Q

What is Zollinger-Ellison syndrome. (3)

A

A rare disorder characterised by the triad of:
Severe peptic ulceration.
Gastric acid hypersecretion.
non beta cell islet tumour of the pancreas (gastrinoma).

Gastrointestinal (35 decks)

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