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GI > Peptic Ulcer Disease > Flashcards

Peptic Ulcer Disease Flashcards

1
Q

What is a peptic ulcer?

A

Breach in the mucosa of the lower oesophagus, stomach or duodenum which fails to heal over time

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2
Q

What is the most common location of a peptic ulcer?

A

Gastric antrum or proximal duodenum

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3
Q

What are the 3 different types of peptic ulcers?

A
  • Oesophageal ulcers
  • Gastric ulcers (pain made worse by eating)
  • Duodenal ulcers (pain eases with eating)
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4
Q

What are the risk factors of peptic ulcer disease?

A
  • Smoking
  • Alcohol
  • Stress
  • H. Pylori
  • Increased gastric acid secretion (Zollinger Ellison Syndrome)
  • Delayed gastric emptying
  • Drugs - NSAIDs, SSRIs, Corticosteroids, Bisphosphonates
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5
Q

What are the clinical features of peptic ulcer disease?

A
  • Nausea
  • Haematemesis or Melaena (due to bleeding)
  • Epigastric pain
  • Duodenal (pain eased by eating) and gastric ulcers (pain made worse by eating)
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6
Q

What is the differential diagnosis of peptic ulcers?

A
  • Non ulcer dyspepsia
  • Duodenal Crohns
  • TB
  • Lymphoma
  • Pancreatic cancer
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7
Q

What is the differential diagnosis of Epigastric pain?

A
  • Dyspepsia
  • GORD
  • Hiatus Hernia
  • Pancreatitis
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8
Q

What are the 3 main causes of peptic ulcer disease?

A
  • H. Pylori
  • NSAIDS
  • GORD
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9
Q

What is the pathophysiology of peptic ulcer disease?

A
  • Involves weakening of defence mechanisms or increased acid attack
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10
Q

What are the 3 main defence mechanisms of peptic ulcer disease?

A
  • Mucus/bicarbonate layer
  • Epithelial cell defences
  • Mucosal blood flow
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11
Q

What are the invasive and non invasive tests for diagnosis of peptic ulcer disease?

A

=> These tests must be performed after more than 2 weeks off PPIs

=> Invasive tests:

  • CLO Test
  • Histology
  • Culture

=> Non-invasive tests:

  • C13 breath test
  • Stool antigen
  • Serology

=> Stool antigen and C13 Breath test are first line

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12
Q

What are the other investigations, excluding the invasive and non invasive tests, in suspected peptic ulcer disease?

A

=> Upper GI Endoscopy
To exclude malignancy

=> Measure gastric acid concentrations
Must be off PPIs for at least 2 months if Zollinger Ellison syndrome suspected

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13
Q

Whats is the management of peptic ulcer disease?

A

=> Main treatment options:

  • Lifestyle (stop smoking ad alcohol)
  • H. Pylori eradication if cause
  • Drugs to reduce gastric acid secretion
  • Discontinue drugs that may cause peptic ulcers
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14
Q

What is the the triple therapy involved in eradication of H. pylori?

A
  • Amoxicillin
  • Clarithromycin
  • Any PPI
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15
Q

What drugs are used to reduce the secretion of gastric acid?

A
  • Lanzoprazole

- Ranitidine

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16
Q

What is the MOA of COX-2 inhibitors?

A
  • Allow prostaglandin secretion

- Prostaglandin is made through the action of COX 1, which does not get inhibited

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