Peptic Ulcer Disease

Question 1

Definition

Answer 1

Ulceration in stomach or duodenum due to imbalance between mucosal protective factors and damaging mechanisms.
Must cross muscularis mucosa.
Common in 1st part duodenum and lesser curve.
Normal defences- mucous, HCO3, BF, PG, epithelial t/o.

Question 2

Aetiology

Answer 2

H pylori urease=NH3
Drugs eg NSAIDs, glucocorticoids
Smoking, alcohol dissolves mucous
Massive stress eg burns=reduced immune function
Incompetent pylorus or LOS
Bile acids
Impaired proximal duodenal bicarb secretion
Decreased BF to gastric mucosa
Acid secreted by parietal cells and pepsinogen secreted by chief cells.

Question 3

Differentials

Answer 3

GORD
Cholelithiasis
Pancreatitis
Gastritis
Crohns, IBS
Nonulcer dyspepsia
Neoplasm eg gastric, lymphoma, pancreatic. 
Angina, MI, pericarditis
Dissecting aneurysm, AAA
High SI obstruction
Pneumonia
Subphrenic abcess
Early appendicitis

Question 4

Management

Answer 4

Stop smoking and alcohol.
Avoid or replace NSAIDs
H2 antagonists eg ranitidine
PPI eg omeprazole
H pylori triple therapy- PPI, amoxicillin, clarithromycin. 
Antacids and sucralfate

Question 5

Symptoms

Answer 5

General-
Epigastric pain can radiate to back. Associated with hunger or after eating certain food. Can be worse at night.
Bloating. Early satiety. Heartburn. Nausea. Fat intolerance.
ALARM Symptoms- Anaemia, Loss of weight, Anorexia, Recent onset/progression, Malaena and haematemesis, swallowing difficulty.
Duodenal-
Epigastric pain before meals of at night. Relieved by eating or drink milk. 50% asymptomatic, others experience recurrence.
Gastric-
Asymptomatic. Epigastric pain. Possibly weight loss.

Question 6

Signs

Answer 6

Epigastric tenderness.

Peritonitis if perforate

gastroduodenal A behing duodenum so bleeding.

Dysphagia

Question 7

Complications

Answer 7

Haematemesis or malaena if BV erosion.
Scarring of duodenum can=pyloric stenosis with vomiting and weight loss.
Slight increase risk gastric CA.

Question 8

Diagnosis

Answer 8

Urease breath test
FBC for anaemia
Upper GI endoscopy especially if progressive dysphagia, vomiting, epigastric mass, iron deficiency.

Question 9

Explanation

Answer 9

• PUD is where you get a ulcer in your stomach or the first part of your intestines. This means an area of damage to the wall. It happens because acid produced by your stomach is able to damage the wall. This is normally stopped by defences such as a mucous lining, production of neutralising substances.
• long term thesis damage can spread further through the wall and even damage blood vessels causing bleeding. It can also lead to scarring, making it more difficult for food to leave the stomac, leading to vomiting. It also slightly increases your risk of stomach cancer.
• it can be due to smoking or alcohol so you should stop that. Also, some drugs such as ibuprofen and aspirin can cause it so if you are taking those you need to stop or find alternatives.
• drug treament can include tablets to stop the stomach from producing as much acid. Also, there is a bacteria which can lead to ulcers, so if you were found to have that, we would give you antibiotics.