Peptic Ulcer Disease Flashcards
what is it
breach of GI mucosa by acid/pepsin attack
more common in developing countries
what kind of ulcers are common
duodenal most common - then gastric - oesophageal rarer but can occur
what is the morphology
clear cut edges, punched out appearance
what is microscopic appearance
layered, floor of necrotic fibropurulent debris, base of inflamed granulation tissue, deepest layer is fibrotic scar tissue
what causes it
H pylori infection - clonises mucous layer of stomach
NSAIDs
Smoking
Chemical irritants
what is H pylori
gram negative microaerophilic flagellated bacillus
oral-oral or faecal oral spread
what are the symptoms
burning epigastric pain dyspepsia loss of appetite and weight aggravated (stomach) or relieved (duodenal) during eating increased acid production feeling of fullness nausea reflux symptoms dark, tarry stools bloody vomit
how to diagnose it
H pylori diagnosis by stool antigen (faecal antigen test), C13 urease breath test, serology (IgG) or in rare cases, biopsy, histology and culture
endoscopy when H pylori -ve to exclude cancer
what is the treatment
H.pylori eradication antacids (gaviscon - bases) H2 antagonists (ranitidine) PPI (omeprazole) withdraw NSAIDs
what is the H.pylori eradication therapy
omeprazole + amoxicillin + clarithromycin OR
omeprazole + metrondiazole + clarithromycin
if triple therapy fails, stop PPI for 2 weeks and retest; try metoclopramide or bismuth chelate
what are the complications
anaemia
bleeding
perforation
gastric outlet / duodenal obstruction - fibrotic scar
