Peptic Ulcer Disease Flashcards
def
ulceration of areas of the GI tract caused by exposure to gastric acid + pepsin
where are peptic ulcers commonly found
1 gastric ulcers
2 duodenal ulcers
aetiology
imbalance between damaging acid + pepsin and protective mucosal mechanisms
associations/risk factors
1 common -helicobacter pylori (95% of duodenal, 70% of gastric) -NSAID use 2 rare -zollinger-ellison syndrome
what is zollinger-ellison syndrome
tumours in pancreas and duodenum
tumours secrete hormone gastrin which causes the stomach to produce excess gastric acid
epi
common
males>females
what age group do duodenal ulcers commonly affect
30yrs
what age group do gastric ulcers commonly affect
50yrs
history
1 epigastric abdominal pain
2 haematemesis/ melaena
what is the pain like in peptic ulcer disease
epigastric abdominal pain
- relieved by antacids
- worse immediately after eating - gastric
- worse hours after eating - duodenal
examination
1 epigastric tenderness
2 signs of complications (anaemia)
what are the ALARM Symptoms for PUD
Anaemia Loss of weight Anorexia Recent onset/progressive symptoms Melaena/haematemesis Swallowing difficulty
how would H. pylori be treated
triple therapy
1 PPI
2 amoxicillin
3 clarithromycin
investigations
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
what is the secretin test
to diagnose zollinger-ellison syndrome
secretin will cause a rise in gastrin in ZE patients but not controls
how would you test for h. pylori
1 (13)C urea breath test
-radiolabelled urea given by mouth to patient, H.pylori metabolizes urea, (13)C detected in expired air
what is more common, gastric or duodenal ulcers
duodenal ulcers are 4 times as common
major risk factors for duodenal ulcers
1 h. pylori
2 NSAIDs
3 steroids
major risk factors for gastric ulcers
1 h.pylori
2 smoking
3 NSAIDs
management
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
complications
1 haemorrhage (haematemesis, meleana)
2 perforation
3 pancreatitis
prognosis
good as peptic ulcers can be treated with h. pylori eradication
