Peptic Ulcer Disease Flashcards
What is a peptic ulcer?
Peptic ulcers involve ulceration of the mucosa of the stomach (gastric ulcer) or the duodenum (duodenal ulcer). Duodenal ulcers are more common.
How do peptic ulcers come about
The stomach mucosa is prone to ulceration from:
Breakdown of the protective layer of the stomach and duodenum
Increase in stomach acid
There is a protective layer in the stomach comprised of mucus and bicarbonate secreted by the stomach mucosa. This protective layer can be broken down by:
Medications (e.g. steroids or NSAIDs)
Helicobacter pylori
What can cause increased acid production?
Stress Alcohol Caffeine Smoking Spicy foods
How do peptic ulcers present?
Epigastric discomfort or pain
Nausea and vomiting
Dyspepsia
Bleeding causing haematemesis, “coffee ground” vomiting and melaena
Iron deficiency anaemia (due to constant bleeding)
TOM TIP: eating typically worsens the pain of gastric ulcers and improves the pain of duodenal ulcers.
How to manage peptic ulcer disease?
Peptic ulcers are diagnosed by endoscopy. During endoscopy a rapid urease test (CLO test) can be performed to check for H. pylori. Biopsy should be considered during endoscopy to exclude malignancy as cancers can look similar to ulcers during the procedure.
Medical treatment is the same as with GORD, usually with high dose proton pump inhibitors. Endoscopy can be used to monitoring the ulcer to ensure it heals and to assess for further ulcers.
What complications can arise from peptic ulcers?
Bleeding from the ulcer is a common and potentially life threatening complication.
Perforation resulting in an “acute abdomen” and peritonitis. This requires urgent surgical repair (usually laparoscopic).
Scarring and strictures of the muscle and mucosa. This can lead to a narrowing of the pylorus (the exit of the stomach) causing difficulty in emptying the stomach contents. This is known as pyloric stenosis. This presents with upper abdominal pain, distention, nausea and vomiting, particularly after eating.
