Peptic Ulcer Disease

Question 1

What is peptic ulcer disease

Answer 1

Erosion of the gastric or duodenal ulcer extending into the submucosa or deeper

Question 2

Which type of ulcer tends to be worse at night

Answer 2

Duodenal

Question 3

What most commonly causes duodenal ulcers

Answer 3

H. Pylori

Question 4

What most commonly causes gastric ulcers

Answer 4

NSAIDS

Question 5

Where does H. Pylori tend to settle

Answer 5

In the antrum of the stomach

Question 6

Describe the underlying pathogenesis of duodenal ulcers

Answer 6

H. Pylori in the antrum causes decreased somatostatin secretion and increased gatrin- more gastric acid

Question 7

Describe the underlying pathogenesis of gastric ulcer

Answer 7

NSAIDS lead to reduced prostaglandins and reduced mucin

Question 8

What is non-ulcer dyspepsia

Answer 8

Symptoms of dyspepsia but endoscopy shows no abnormalities or ulcers

Question 9

How should non-ulcer dyspepsia be managed

Answer 9

Improves with time and treatment of the symptoms (PPI)

Question 10

What investigations should be done

Answer 10

• Urea breath test/ stool antibody test
• FBC
• Endoscopy is aged over 55/ red flag symptoms

Question 11

When would a barium swallow be used

Answer 11

When the patient can’t tolerate an endoscopy

Question 12

How are peptic ulcers treated

Answer 12

Triple therapy if H. Pylori detected

Question 13

Name some complications of peptic ulcers

Answer 13

Perforation
GI bleeds
Gastric outlet obstruction

Question 14

Describe the action of H. Pylori in the production of excess acid

Answer 14

• Produces ammonia to neutralise acidity
• Lives in crypts next to acidic centres of stomach acid
• Excess acid produced

Question 15

What would board like rigidity suggest

Answer 15

Perforation

Question 16

What is seen on a CT abdomen if a perforation has occured

Answer 16

Air under the diaphragm

Question 17

Do men or women get ulcers more

Answer 17

M

Question 18

What is the most common site of duodenal ulcer perforation

Answer 18

Anterior duodenum

Question 19

Describe the classic presentation of a patient with a perforated peptic ulcer

Answer 19

• Severe pain, beginning epigastric and becoming localised
• Shock
• Peritonitis

Question 20

What is the immediate action when a patient presents with a perforated peptic ulcer

Answer 20

’ Drip and suck ‘

• IV fluids
• NG tube to empty the stomach

Question 21

Describe the surgical repair used for a perforated peptic ulcer

Answer 21

Peritoneal washout and surgical repair with a patch of omentum

Question 22

Are gastric or duodenal ulcers likely to be/ become malignant

Answer 22

GASTRIC