Peptic Ulcer Disease

Question 1

Symptoms of peptic ulcer disease

Answer 1

Recurrent burning epigastric pain - worse at night and after meals
Weight loss, nausea and vomiting, bloating, dyspepsia

Question 2

Signs of peptic ulcer

Answer 2

Epigastric tenderness

Question 3

Investigations of peptic ulcer

Answer 3

Endoscopy/colonoscopy to exclude cancer
Biopsy to investigate h.pylori
Urease breath test

Question 4

Pathophysiology of peptic ulcer disease

Answer 4

A break in the superficial epithelial cells of the muscularis mucosa of the stomach or duodenum.
Underlying layers exposed to acid

Question 5

Causes of peptic ulcer disease

Answer 5

Helicobacter pylori infection
NSAIDs
Smoking

Question 6

How does h.pylori cause damage

Answer 6

Produces urease enzyme that breaks down urea to ammonia and reduces acidity in the stomach. Ammonia is toxic, degrades mucus layer.

Question 7

Management of peptic ulcer disease

Answer 7

Give PPI eg. Omeprazole, lansoprazole, esomeprazole
Give H2-antagonists eg. Ranitidine

Eradicate h.pylori with triple therapy: PPI + clarythromycin + amoxicillin

Question 8

Differentials of peptic ulcer disease

Answer 8

Functional dyspepsia
Stomach cancer
Zollinger-Ellison syndrome
Cholecystitis
GORD

Question 9

Prognosis of peptic ulcer disease

Answer 9

Usually heal within a month or 2