Peptic Ulcer Disease

Question 1

def

Answer 1

ulceration of areas of the GI tract caused by exposure to gastric acid + pepsin

Question 2

where are peptic ulcers commonly found

Answer 2

1 gastric ulcers

2 duodenal ulcers

Question 3

aetiology

Answer 3

imbalance between damaging acid + pepsin and protective mucosal mechanisms

Question 4

associations/risk factors

Answer 4

1 common
-helicobacter pylori (95% of duodenal, 70% of gastric)
-NSAID use
2 rare
-zollinger-ellison syndrome

Question 5

what is zollinger-ellison syndrome

Answer 5

tumours in pancreas and duodenum

tumours secrete hormone gastrin which causes the stomach to produce excess gastric acid

Question 6

epi

Answer 6

common

males>females

Question 7

what age group do duodenal ulcers commonly affect

Answer 7

30yrs

Question 8

what age group do gastric ulcers commonly affect

Answer 8

50yrs

Question 9

history

Answer 9

1 epigastric abdominal pain

2 haematemesis/ melaena

Question 10

what is the pain like in peptic ulcer disease

Answer 10

epigastric abdominal pain

• relieved by antacids
• worse immediately after eating - gastric
• worse hours after eating - duodenal

Question 11

examination

Answer 11

1 epigastric tenderness

2 signs of complications (anaemia)

Question 12

what are the ALARM Symptoms for PUD

Answer 12

Anaemia
Loss of weight
Anorexia
Recent onset/progressive symptoms
Melaena/haematemesis
Swallowing difficulty

Question 13

how would H. pylori be treated

Answer 13

triple therapy
1 PPI
2 amoxicillin
3 clarithromycin

Question 14

investigations

Answer 14

1 bloods
-FBC (anaemia)
-amylase (exclude pancreatitis)
-secretin test
2 endoscopy
-gastric ulcer biopsy to exclude malignancy
3 rockall scoring
-for severity in GI bleed
-<3 good prognosis
->8 bad prognosis
4 testing for H.pylori

Question 15

what is the secretin test

Answer 15

to diagnose zollinger-ellison syndrome

secretin will cause a rise in gastrin in ZE patients but not controls

Question 16

how would you test for h. pylori

Answer 16

1 (13)C urea breath test

-radiolabelled urea given by mouth to patient, H.pylori metabolizes urea, (13)C detected in expired air

Question 17

what is more common, gastric or duodenal ulcers

Answer 17

duodenal ulcers are 4 times as common

Question 18

major risk factors for duodenal ulcers

Answer 18

1 h. pylori
2 NSAIDs
3 steroids

Question 19

major risk factors for gastric ulcers

Answer 19

1 h.pylori
2 smoking
3 NSAIDs

Question 20

management

Answer 20

1 endoscopy
-haemostasis by injection sclerotherapy (coagulation of blood)
2 surgical
-single perforated ulcers sewn together
-chronic/many ulcers partial gastrectomy
3 medical
-h. pylori triple therapy
-if not associated with h. pylori use PPIs/H2-antagonists
-stop NSAID use

Question 21

complications

Answer 21

1 haemorrhage (haematemesis, meleana)
2 perforation
3 pancreatitis

Question 22

prognosis

Answer 22

good as peptic ulcers can be treated with h. pylori eradication