Peptic Ulcer Disease Flashcards
Define peptic ulcer disease
An umbrella term for a gastric or duodenal ulcer
Define gastritis
Anything causing inflammation/irritation to the stomach lining
List 10 symptoms of peptic ulcer disease :)
- Dyspepsia; indigestion
- Anorexia
- Nausea
- Vomiting
- Hematemesis; vomiting blood
- Malena
- Heartburn
- Acid brash: feeling like you’ve vomited in your mouth (+ a wave of saliva to attempt to neutralize the acidity)
- Abdominal pain
- Gastro-esophageal reflux
What is Malena indicative of and why?
Upper GI bleed as the blood as then been digested and travelled through the GI tract before appearing in the stools
Name 7 causes for Ulcer disease
- Acid
- Diet; spicy food and lots of caffeine
- Alcohol
- Smoking
- Stress
- NSAIDs
- H.pylori
What is Zollinger Ellison syndrome?
*Hint: another cause for ulcer disease!
A gastrin secreting tumour in the pancreas
Where does Helicobacter pylori live in the gut?
Buries itself in the gastric mucosal lining
How does H.p’s production of urease aid the bacteria and affect the gut?
- Highly immunogenic: causes local inflammation that can lead to it becoming a chronic infection
- Urease breaks down urea in the stomach into CO2 and ammonia: ammonia neutralizes the surrounding stomach acid, creating a protective ‘bubble’. Ammonia is also toxic to epithelial cells
How do the proteins produced by H.p affect the gut?
Proteins like proteases and vacuolating cytotoxin A damage epithelia, tight junctions and cause apoptosis
What is the name of the cytotoxin produced by H.p that causes inflammation and is a potential carcinogen?
CagA
Name 3 ways you could diagnose H.pylori
- Urea breath test
- Blood test: can look for antibodies
- Stool test: antibodies
What’s the issue with diagnosing H.pylori with a blood test?
Antibodies can stay in the blood for a long time, so it can be difficult to identify whether the antibodies are from a previous infection and if the antibiotics given were effective.
Why does h.pylori colonize different areas of the gut?
In individuals that produce a lot of acids; H.pylori tends to colonize near the pyloric antrum/exit to the duodenum to avoid the acid-secreting parietal cells in the fundus
In individuals producing normal/reduced amounts of acid: H.p will colonize anywhere in the stomach
What happens as a result of inflammation (in this case caused by bacteria) in the pyloric antrum?
The inflammatory response induces G cells in the antrum to secrete gastrin -> travels through the bloodstream to parietal cells in the fundus where it increases acid production
The duodenal cap/beginning becomes damaged over time, leading to metaplasia of the gastric mucosa
H.p can go on to colonize the gastric mucosa in the duodenum and cause duodenitis as a result of its immune response
What will likely happen if H.pylori dominantly colonizes in the following areas?
- Antrum
- Antrum and Body
- Body
- Duodenal ulcer risk
- Largely asymptomatic
- Gastric ulcer and cancer risk
What is the danger of a peptic ulcer in the pyloric sphincter?
If large enough can cause a pyloric obstruction and erode blood vessels
When is pain typically felt in individuals suffering from a duodenal vs gastric ulcer?
Duodenal: less pain when they eat
Gastric: more pain when they eat
Why do NSAIDs exacerbate peptic ulcer disease?
They block the function of cyclooxygenase 1 (cox-1) - which is essential for the production of prostaglandins
Why are COX-2 selective anti-inflammatories less dangerous?
The COX2 pathway is less essential to the gastric mucosa, (unlike the COX1 pathway which directly contributes to the production of prostaglandins!)
Name 6 causes of upper GI bleeds
- Peptic ulcers; slow bleed
- Gastroduodenal erosions
- Mallory Weiss Tear: persistent vomiting for >24 hours (for whatever reason) can cause a tear in the stomach lining
- Esophageal varicies
- Vascular malformations
- Upper GI malignancy
Try to list 6 symptoms and 3 signs an individual with an upper GI bleed might have
Symptoms: hematemesis (coffee-ground vomit), dizziness, fainting, abdominal pain, cool and clammy peripheries (with delayed CPT), low urine output
Signs: Low JVP, hypotension and tachycardia
Name four important aspects of a history from a patient with suspected peptic ulcer disease
- Previous peptic ulceration/upper GI symptoms
- Current medication and over the counter analgesics (like aspirin)
- Bleeding disorders; warfarin
- Previous drug use and alcohol intake
What three steps might you take to immediately manage a patient with an upper GI bleed
- Take them off any contributing drugs; NSAIDs, aspirin, clopidogrel, etc
- Send for endoscopy
- If they are in shock give crystalloids
What can you do for rheumatoid patients that have acquired an upper GI bleed?
Consider COX-2 inhibitors if there is no cardiac disease
