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Case 19 Diseases of the Upper GI tract > Peptic Ulcer Disease > Flashcards

Peptic Ulcer Disease Flashcards

1
Q

What is a peptic ulcer?

A

ulcer’ refers to an ulcer in the lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to the stomach or, rarely, in the ileum adjacent to a Meckel’s diverticulum

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2
Q

What is the definition of chronic ulcer?

A

One that penetrates the muscularis mucosa and shows evidence of fibrosis

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3
Q

What are the symptoms of an ulcer?

A
  • Pain – epigastric that radiates up to neck, down to umbilicus or to the back. Last from a few minutes to hour and often starts after eating.
  • Indigestion
  • Heartburn
  • Anorexia
  • Nausea and vomiting
  • Weight loss
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4
Q

What causes it?

A

lesions in the lining of the gastrointestinal mucosa caused by the action of pepsin and stomach acid

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5
Q

What are the commonest causes of PUD?

A

Infection with H Pylori and NSAID use

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6
Q

How is H Pylori diagnosed?

A

a urea breath test and a stool antigen test

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7
Q

How is H Pylori treated?

A

treatment is based upon a PPI taken simultaneously with two antibiotics (from amoxicillin, clarithromycin and metronidazole) for 7 days

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8
Q

What is treatment for NSAID induced PUD?

A

stop NSAID and give 4-8 wk course of full dose PPIs

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9
Q

What are risk factors for PUD?

A

Smoking

Excessive alcohol intake

FH of PUD

Physical stress

Hypersecretory syndromes which increase production of stomach acid – e.g. Zollinger-Ellison Syndrome

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10
Q

How is PUD investigated?

A

Endoscopy and Biopsy

Test for H Pylori

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11
Q

What are the signs of a bleeding peptic ulcer?

A

Internal bleeding may cause an iron deficiency anaemia or if the ulcer erodes an artery a massive life-threatening upper gastrointestinal bleed.

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12
Q

What are the symptoms of an upper GI bleed?

A

Anaemia, haematemesis, malaena

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13
Q

What is a perforated ulcer?

A

the ulcer completely erodes through the lining of stomach or more commonly duodenum and stomach fluids and air escape into the peritoneal cavity

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14
Q

What are the symptoms of perforation?

A

Acute abdomen, peritonitis, initially in upper abdomen then generalised. BS absent. liver dullness. abdomen immobile and rigid.

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15
Q

How is perforation diagnosed?

A

Erect CXR or contract swallow

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16
Q

How is perforation managed?

A

Emergency closure or pyloroplasty

17
Q

What are the signs of gastric Outlet Obstruction?

A

epigastric abdominal pain, postprandial vomiting, visible gastric peristalsis

18
Q

What are main causes of gastric outlet obstruction?

A

Fibrotic stricture from ulcer or malignancy

19
Q

What are risk factors for developing gastric cancers?

A

Chronic gastritis and H Pylori infection

20
Q

How is an acute upper GI bleed managed?

A

1) IV access
2) Resuscitation - fluids, blood
3) basic investigations - FBC, U&Es, LFTs, PT time, Cross match
4) Blatchford score - risk assess
5) Oxygen - patients in shock
6) Endoscopy + Rockall scoring

21
Q

What is an isolated raised urea a sign off?

A

Upper GI bleed and burns patients

22
Q

How is a non-variceal bleed managed?

A

Endoscopic treatment -

clips w or w/o adrenaline

Thermal coagulation with adrenaline

Fibrin or thrombin with adrenaline

PPIs

23
Q

How are oesophageal variceal bleeds managed?

A

terlipressin, prophylactic antibiotic therapy, band ligation or transjugular intrahepatic portosystemic shunts if that doesn’t work

24
Q

What is the treatment for gastric varices?

A

terlipressin, antibiotic therapy, injection of N-butyl-2-cyanoacrylate or TIPS if injection doesn’t work

25
Q

What causes a mallory-weiss tear?

A

Alcohol intoxication, self-induced vomiting, pregnancy

26
Q

What are the recommendations for endoscopy in upper GI bleeds?

A
  • Offer endoscopy to unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation.
  • Offer endoscopy within 24 hours of admission to all other patients with upper gastrointestinal bleeding.
27
Q

Which two vessels does TIPS connect

A

connects the hepatic vein to the portal vein

28
Q

How are oesophageal varices managed prophylactically?

A

Propanolol

or

endoscopic variceal band ligation (EVL)

Case 19 Diseases of the Upper GI tract (2 decks)

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