Peptic ulcer disease Flashcards
What is a peptic ulcer?
Break in the lining of the gastrointestinal tract extending through to the muscular mucosae of the bowel wall
What are peptic ulcers most common?
lesser curve of the proximal stomach and first part of the duodenum
What usually protects the stomach from ulceration?
surface mucous secretions and HCO3- ion release
When does ulceration occur in the GI tract?
If there is overwhelming presence of noxious substances or when these natural barriers are impaired, so usually H pylori or NSAIDs
What are some less common causes of ulceration?
high alcohol intake, steroids, batteries, Zollinger Ellison syndrome
Why do NSAIDs increasingly ulceration risk?
inhibit prostaglandin synthesis so less glycoprotein, mucous and phospholipids by the gastric epithelial cells, which would contribute to the barrier protecting the gastric mucosa
What kind of bacteria is H pylori?
gram negative spiral-shaped bacillus
How does H pylori survive in the stomach?
by producing alkaline micro environments and inducing an inflammatory response in the mucosa leading to ulceration
How does h pylori cause ulceration in the stomach?
cytokine and interleukin driven inflammatory response, increased gastric acid secretion as increased histamine which acts on parietal cells, damage host mucous secret by degrading surface glycoproteins and down regulating bicarbonate production
What are the clinical features of peptic ulcer disease?
asymptomatic, gastric ulcer- epigastric pain after eating, nausea, vomiting, weight loss, duodenal ulcer will probably just have pain worse 2-5hours after eating, but is alleviated by eating
What is the ALARMS mnemonic for?
anemia, lost weight, anorexia, recent rapid onset, malaena, swallowing difficulties which may mean malignancy
What are the differential diagnosis for peptic ulcer disease?
gastric malignancy, pancreatitis, acute coronary syndrome, GORD and gallstone disease
What is Zollinger Ellison syndrome?
Severe peptic ulcer disease, gastric acid hyper secretion and gastronome, with gasting gastrin level of over 1000pg/ml,usually discorvered as part of MEN 1 syndrome
What are the investigations for peptic ulcer disease?
OGD and biopsy, sent for a rapid urease CLO test which will show presence of H pylori, or if dont need an OGD can do carbon 13-urea breath test, serum antibodies to H pylori, stool antigen test
What should patients do to prevent false negative H pylori testing?
Stop any current medical therapy for 2 weeks
