Peptic Ulcer Disease Flashcards
What level does the pyloric sphincter sit at?
L1
What structure does the greater omentum adhere to?
the transverse colon
what nerve supplies the pyloric sphincter region?
the nerve of latarjet - which is a branch of the Vagus nerve
posterior ulcers in the first part of the duodenum risk eroding which artery?
the gastroduodenal artery
what structure marks the end of the embryonic foregut?
the duodenal papilla
At what level is the 2nd part of the duodenum?
L2/3
Ulcers in what structure may erode the abdominal aorta?
in the 2nd part of the duodenum
where does the duodenum become the jejunum?
at the duodenojejunal flexure/junction (about level L1)
what ligament anchors the duodenal jejunal flexure to the diaphragm?
Ligament of Treitz
what are the four anatomical regions of the stomach?
cardia, fundus, corpus and antrum
describe the surfaces of the stomach
the surface of the stomach exhibits coarse rugae - infoldings of mucosa and submucosa
microscopically the mucosa is punctuated by gastric pits (glands)
what cells live in which region of the stomach?
ex answer) the … cells live in the corpus of the stomach
Cardia = loosely packed mucous secreting glands
Corpus/Fundus = parietal cells (acid/intrinsic factor/histamine producing)
Antrum = mucous secreting glands and G cells (produce gastrin, serotonin, somatostatin)
by what mechanisms does the stomach protect itself from erosion?
through
1) mucous secretion
2) bicarbonate secretion
3) epithelial barrier
4) Mucosal Blood Flow (provides bicarb, O2, nutrients)
where in the stomach do the strongest peristaltic contractions occur?
in the antrum
Increased gastric emptying occurs as a result of what?
- mechanical distension
- increased parasympathetic activity
- action of gastrin (produced by G cells)
What factors slow gastric emptying?
slowed by acid or fat in duodenum
expediting pH neutralisation and intestinal lipid absorption
what are the risk factors for Peptic Ulcer Disease?
- smoking
- alcohol
- stress
- NSAIDs
- Corticosteroids
what is the most common cause of peptic ulcers?
Helicobactor Pylori infection
how do we detect H. Pylori?
- circulating antibodies
- urea production in breath test
*
what are the symptoms of peptic ulcers?
aching/burning epigastric pain
pain that tends to appear soon after eating
back pain
symptoms of anaemia
what are the signs of peptic ulcer disease?
epigastric tenderness
(if perforated gaurding, rebound, and rigidity either localized or generalised)
signs of anaemia
haematemesis
melaena
what investigations do we perform for gastric ulcers?
gastrin levels
radiographic studies
endoscopy
what treatment do we offer for peptic ulcers?
If H.Pylori positive = Triple Therapy
- Clarithromycin
- Amoxicillin
- PPI
why might a peptic ulcer fail to heal after treatmetn?
- non-compliance
- NSAID abuse
- Crohn’s Disease
- Gastrin Secreting tumour
- Malignancy
