Peptic Ulcer disease Flashcards
how would you define peptic ulcer disease?
breaches in the gastric or duodenal mucosa
Where do most peptic ulcers occur?
95% in the duodenum (duodenal cap)
What are some risk factors for duodenal ulcers?
H pylori, drugs (NSAIDs, steroids), smoking, alcohol, increased gastric emptying, blood group O
what are some risk factors for gastric ulcers?
H.pylori, smoking, drugs, delayed gastric emptying, stress
how do peptic ulcers present?
epigastric pain
duodenal: pain worse before meals and at night, usually relieved by eating or milk
gastric ulcers: worse on eating and relieved by antacids
what are some complications of peptic ulcers?
bleeding, perforation, gastric outflow obstruction, malignancy (esp with H.pylori)
how may a bleeding peptic ulcer present?
haematemesis, iron deficiency anaemia, ?melaena
how may a perforation present?
peritonitic or massive bleeding
how may gastric outflow obstruction be managed?
vomiting, colic, distension
how do peptic ulcers lead to gastric outflow obstruction?
fibrosis around ulcers causes scarring of pylorus or duodenal bulb
why does zollinger-ellison cause peptic ulcers?
the tumours cause the stomach to produce more acid which leads to peptic ulcers
how long do you have to have stopped taking PPIs before an OGD for suspected peptic ulcers?
2 weeks
what are some conservative management options for peptic ulcers?
lose weight
stop smoking or alcohol
avoid hot drinks and spicy food
stop drugs such as NSAIDs, steroids
What medical management of peptic ulcers are available?
OTC antacids e.g. gaviscon
PPIs e.g. 30mg OD lansoprazole
H2 antagonists e.g. 300mg ranitidine at night
name 3 possible surgical options for managing peptic ulcers?
vagotomy
antrectomy with vagotomy
subtotal gastrectomy
whats the management for H.pylori eradication?
PAC500- PPI, amoxicillin, clarithromycin (500mg)
PMC250- PPI, metronidazole, clarithromycin (250mg)
what are the metabolic complications of peptic ulcers?
dumping syndrome- abdo distension, flushing, N+V (early: osmotic hypovolaemia, late: reactive hypoglycaemia)
blind loop syndrome- malabsorption, diarrhoea, overgrowth of bacteria in duodenal stump, anaemia (Fe or B12), wt loss
what is the commonest cause of gastritis?
H.pylori
how is h.pylori transmitted?
faecal oral route
which strain of H.pylori has oncogenic properties?
CagA +ve H.pylori
name 2 tests for H.pylori
urease breath test, campylobacter-like organism (CLO) test
what is the scientific basis for the urease breath test in H.pylori?
H.pylori produces urease which converts urea to ammonia and carbon dioxide.
PPIs can lead to osteoporosis and therefore fractures if used long term- true or false
true
Peptic ulceration, galactorrhoea, hypercalcaemia - Whats the diagnosis?
multiple endocrine neoplasia type I
