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Jess GI > Peptic Ulcer Disease > Flashcards

Peptic Ulcer Disease Flashcards

1
Q

Define peptic ulcer disease

A

An umbrella term for a gastric or duodenal ulcer

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2
Q

Define gastritis

A

Anything causing inflammation/irritation to the stomach lining

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3
Q

List 10 symptoms of peptic ulcer disease :)

A
  1. Dyspepsia; indigestion
  2. Anorexia
  3. Nausea
  4. Vomiting
  5. Hematemesis; vomiting blood
  6. Malena
  7. Heartburn
  8. Acid brash: feeling like you’ve vomited in your mouth (+ a wave of saliva to attempt to neutralize the acidity)
  9. Abdominal pain
  10. Gastro-esophageal reflux
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4
Q

What is Malena indicative of and why?

A

Upper GI bleed as the blood as then been digested and travelled through the GI tract before appearing in the stools

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5
Q

Name 7 causes for Ulcer disease

A
  1. Acid
  2. Diet; spicy food and lots of caffeine
  3. Alcohol
  4. Smoking
  5. Stress
  6. NSAIDs
  7. H.pylori
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6
Q

What is Zollinger Ellison syndrome?

*Hint: another cause for ulcer disease!

A

A gastrin secreting tumour in the pancreas

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7
Q

Where does Helicobacter pylori live in the gut?

A

Buries itself in the gastric mucosal lining

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8
Q

How does H.p’s production of urease aid the bacteria and affect the gut?

A
  1. Highly immunogenic: causes local inflammation that can lead to it becoming a chronic infection
  2. 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
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9
Q

How do the proteins produced by H.p affect the gut?

A

Proteins like proteases and vacuolating cytotoxin A damage epithelia, tight junctions and cause apoptosis

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10
Q

What is the name of the cytotoxin produced by H.p that causes inflammation and is a potential carcinogen?

A

CagA

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11
Q

Name 3 ways you could diagnose H.pylori

A
  1. Urea breath test
  2. Blood test: can look for antibodies
  3. Stool test: antibodies
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12
Q

What’s the issue with diagnosing H.pylori with a blood test?

A

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.

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13
Q

Why does h.pylori colonize different areas of the gut?

A

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

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14
Q

What happens as a result of inflammation (in this case caused by bacteria) in the pyloric antrum?

A

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

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15
Q

What will likely happen if H.pylori dominantly colonizes in the following areas?

  1. Antrum
  2. Antrum and Body
  3. Body
A
  1. Duodenal ulcer risk
  2. Largely asymptomatic
  3. Gastric ulcer and cancer risk
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16
Q

What is the danger of a peptic ulcer in the pyloric sphincter?

A

If large enough can cause a pyloric obstruction and erode blood vessels

17
Q

When is pain typically felt in individuals suffering from a duodenal vs gastric ulcer?

A

Duodenal: less pain when they eat
Gastric: more pain when they eat

18
Q

Why do NSAIDs exacerbate peptic ulcer disease?

A

They block the function of cyclooxygenase 1 (cox-1) - which is essential for the production of prostaglandins

19
Q

Why are COX-2 selective anti-inflammatories less dangerous?

A

The COX2 pathway is less essential to the gastric mucosa, (unlike the COX1 pathway which directly contributes to the production of prostaglandins!)

20
Q

Name 6 causes of upper GI bleeds

A
  1. Peptic ulcers; slow bleed
  2. Gastroduodenal erosions
  3. Mallory Weiss Tear: persistent vomiting for >24 hours (for whatever reason) can cause a tear in the stomach lining
  4. Esophageal varicies
  5. Vascular malformations
  6. Upper GI malignancy
21
Q

Try to list 6 symptoms and 3 signs an individual with an upper GI bleed might have

A

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

22
Q

Name four important aspects of a history from a patient with suspected peptic ulcer disease

A
  1. Previous peptic ulceration/upper GI symptoms
  2. Current medication and over the counter analgesics (like aspirin)
  3. Bleeding disorders; warfarin
  4. Previous drug use and alcohol intake
23
Q

What three steps might you take to immediately manage a patient with an upper GI bleed

A
  1. Take them off any contributing drugs; NSAIDs, aspirin, clopidogrel, etc
  2. Send for endoscopy
  3. If they are in shock give crystalloids
24
Q

What can you do for rheumatoid patients that have acquired an upper GI bleed?

A

Consider COX-2 inhibitors if there is no cardiac disease

25
Q

Explain the Blatchford score

A

It is a prognostic marker that considers urea, Hb, spontaneous bacterial peritonitis (bacterial infection of peritoneum), and other signs

Score 0: early discharge without endoscopy
Score <4: low probability for any urgent need for endoscopy

26
Q

Name three therapeutics that can be provided before the patient is sent for an endoscopy

A
  1. Proton pump inhibitors
  2. Antifibrinolytics; inhibits activation of plasminogen-> plasmin which preventing the break up of fibrin (maintains the clot)
  3. Prokinetics:
27
Q

Name one commonly used antifibrinolytic

A

Transexamic acid

28
Q

Name 4 ways bleeding can be managed endoscopically and explain each one

A
  1. Injection sclerotherapy: injecting medicine into blood vessels causing them to shrink
  2. Diathermy: burning vessels to promote clot
  3. Variceal Ligation: tying off a vein in esophageal varicies
  4. Laser therapy
  5. Endoscopic clipping (ligates the feeding vessels)
29
Q

What is the major concern for an untreated ulcer?

A

Perforation

30
Q

Where would you spot a stomach perforation in an x-ray?

A

When the patient is upright; air will rise and can be seen sitting above the diaphragm (skinny half moons)

Jess GI (17 decks)

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