Peptic Ulcer Disease Flashcards
What is a peptic ulcer?
A break in the lining of the GI tract, extending through to the muscular layer (muscularis mucosae) of the bowel wall
Where is the most common location of a peptic ulcer?
Lesser curvature of the proximal stomach
OR
First part of the duodenum
What is the pathophysiology of peptic ulcers?
Imbalance between factors that promote mucosal damage and the mechanisms that promote gastroduodenal defence.
What factors promote damage to the gastroduodenal mucosa?
- Gastric acid
- Pepsin
- H. Pylori
- NSAIDs
What are the mechanisms that protect the gastroduodenal mucosa?
- Prostaglandins
- Mucus
- Bicarbonate
- Mucosal blood flow
What are risk factors for peptic ulcer disease?
- NSAID use
- H. pylori infection
- Increasing age
- Smoking
- Personal / Family history of peptic ulcer disease
- Intensive care stay
What are the most common causes of peptic ulcers?
H.Pylori
NSAIDs
How does NSAID use cause peptic ulcers?
Inhibits prostaglandin synthesis, resulting in reduced gastro-protective secretion of glycoprotein, mucous, and phospholipids by the gastric epithelial cells.
What is Helicobacter pylori?
A Gram -ve spiral-shaped bacillus, found in the mucous layer of those with duodenal ulcers (90%) or gastric ulcers (70%)
How does H. Pylori cause peptic ulcers?
It produces an alkaline micro-environment & induces an inflammatory response in the mucosa, leading to eventual ulceration, by:
- Invoking an cytokine and interleukin-driven inflammatory response
- Increasing gastric acid secretion in both the acute and chronic phases of infection, by inducing the release of histamine which acts on parietal cells
- Damaging host mucous secretion by degrading surface glycoproteins and down-regulating bicarbonate production
Aside from NSAID use & H. Pylori infection, what are other causes of peptic ulcer disease?
- Certain medications
- Corticosteroids (when used with NSAIDs)
- SSRIs
- Bisphosphonates
- Zollinger-Ellison syndrome (rare)
- Prev. gastric bypass surgery
- Physiological stress, such as:
- Gastric ischaemia
- Head trauma (Cushing’s ulcer)
- Severe burns (Curling’s ulcer)
- Crohn’s
- Infection (e.g. HIV, herpes)
What is Zollinger-Ellison Syndrome?
Triad of:
- Severe peptic ulcer disease
- Gastric acid hyper-secretion
- Gastrinoma
What percentage of peptic ulcers are asymptomatic?
Up to 70%
What symptoms can peptic ulcer disease present with?
- Epigastric or retrosternal pain (Dyspepsia)
- Can radiate through to back w duodenal ulcers that penetrate into pancreas
- Nausea & vomiting
- Bloating
- Post-prandial discomfort (Pain after meals)
- Early satiety
- Complications of peptic ulcer disease (less common)
- Bleeding
- Perforation
- Gastric outlet obstruction
How is the typical pattern of pain different between gastric ulcers and duodenal ulcers?
Gastric ulcers = Pain WORSENED by eating
Duodenal ulcers = Pain RELIEVED by eating (or worse 2-4 hrs after)