Peptic Ulcer Disease

Question 1

Is peptic ulcer disease more common in men or woman?

Answer 1

men

Question 2

what are the causes of peptic ulcer disease?

Answer 2

• H. pylori infection
• smoking
• alcohol
• NSAID use

Question 3

How is H.pylori able to survive in the stomach?

Answer 3

it produces ammonia which is able to neutralise the acid around the cell, and thus enable the cell to survive.

Question 4

what is the result of H.pylori living in crypts in the stomach?

Answer 4

as the crypts are next to the acidic sensors of stomach acid, the normal feedback mechanism is altered and excess acid is produced.

Question 5

What does H.pylori cause in the stomach?

Answer 5

causes localised inflammation and the body’s own stomach acid can worsen the effects of the inflammation.

Question 6

What are the symptoms of peptic ulcer disease?

Answer 6

• epigastric pain
• vomiting (rare) may relieve pain
• weight loss (patients may eat less to try and avoid pain)
• 50% of patients are asymptomatic
• tiredness (aneamia)

Question 7

what symptom may suggest that the ulcer is duodenal in peptic ulcer disease?

Answer 7

pain may be worse at night

Question 8

what symptom may suggest the ulcer is gastric in peptic ulcer disease?

Answer 8

pain worse on eating, or just before eating, when acid is produced

Question 9

What is the first line investigation for peptic ulcer disease?

Answer 9

stool test - test for H.pylori. PPIs must be stopped a week before

Question 10

What other investigations may be done in peptic ulcer disease?

Answer 10

urea breath test
serum IgG
endoscopy
FBC
fecal occult blood

Question 11

What treatment is given for peptic ulcer disease?

Answer 11

PPI and antibiotic eradication therapy (as well as stopping smoking).
triple therapy (PPI and two ABs) - omeprazole, metronidazole and clarithromycin 2x daily, antibiotics are taken for 7 days but PPI for a furthur 3-4 weeks

Question 12

what are the complications of peptic ulcer disease?

Answer 12

perforation
haemorrhage
aneamia
cancer

Question 13

what are the symptoms if the ulcer perforates in peptic ulcer disease?

Answer 13

pain - sudden onset - epigastric region and may radiate to back
peritonitis
absent bowel sounds
shock
shallow breathing due to diaphragmatic irritation 
fever 
tachycardia 
X-ray may show gas under diaphragm

Question 14

what is the mortality for when an ulcer perforates in peptic ulcer disease?

Answer 14

25%