Peptic Ulcer Disease Flashcards
What is a peptic ulcer?
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
What is the definition of chronic ulcer?
One that penetrates the muscularis mucosa and shows evidence of fibrosis
What are the symptoms of an ulcer?
- 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
What causes it?
lesions in the lining of the gastrointestinal mucosa caused by the action of pepsin and stomach acid
What are the commonest causes of PUD?
Infection with H Pylori and NSAID use
How is H Pylori diagnosed?
a urea breath test and a stool antigen test
How is H Pylori treated?
treatment is based upon a PPI taken simultaneously with two antibiotics (from amoxicillin, clarithromycin and metronidazole) for 7 days
What is treatment for NSAID induced PUD?
stop NSAID and give 4-8 wk course of full dose PPIs
What are risk factors for PUD?
Smoking
Excessive alcohol intake
FH of PUD
Physical stress
Hypersecretory syndromes which increase production of stomach acid – e.g. Zollinger-Ellison Syndrome
How is PUD investigated?
Endoscopy and Biopsy
Test for H Pylori
What are the signs of a bleeding peptic ulcer?
Internal bleeding may cause an iron deficiency anaemia or if the ulcer erodes an artery a massive life-threatening upper gastrointestinal bleed.
What are the symptoms of an upper GI bleed?
Anaemia, haematemesis, malaena
What is a perforated ulcer?
the ulcer completely erodes through the lining of stomach or more commonly duodenum and stomach fluids and air escape into the peritoneal cavity
What are the symptoms of perforation?
Acute abdomen, peritonitis, initially in upper abdomen then generalised. BS absent. liver dullness. abdomen immobile and rigid.
How is perforation diagnosed?
Erect CXR or contract swallow
How is perforation managed?
Emergency closure or pyloroplasty
What are the signs of gastric Outlet Obstruction?
epigastric abdominal pain, postprandial vomiting, visible gastric peristalsis
What are main causes of gastric outlet obstruction?
Fibrotic stricture from ulcer or malignancy
What are risk factors for developing gastric cancers?
Chronic gastritis and H Pylori infection
How is an acute upper GI bleed managed?
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
What is an isolated raised urea a sign off?
Upper GI bleed and burns patients
How is a non-variceal bleed managed?
Endoscopic treatment -
clips w or w/o adrenaline
Thermal coagulation with adrenaline
Fibrin or thrombin with adrenaline
PPIs
How are oesophageal variceal bleeds managed?
terlipressin, prophylactic antibiotic therapy, band ligation or transjugular intrahepatic portosystemic shunts if that doesn’t work
What is the treatment for gastric varices?
terlipressin, antibiotic therapy, injection of N-butyl-2-cyanoacrylate or TIPS if injection doesn’t work
What causes a mallory-weiss tear?
Alcohol intoxication, self-induced vomiting, pregnancy
What are the recommendations for endoscopy in upper GI bleeds?
- 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.
Which two vessels does TIPS connect
connects the hepatic vein to the portal vein
How are oesophageal varices managed prophylactically?
Propanolol
or
endoscopic variceal band ligation (EVL)
