Peptic Ulcer Disease

Question 1

Causes of PUD

Answer 1

1. Helicobacter pylori
2. Alcohol and smoking
3. NSAIDS use
4. Genetic susceptibility
5. Hypercalcemia and chronic steroid use
6. Chronic liver ,chronic lung and chronic pancreatitis
7. Crohns and duodenal lymphoma or adenocarcinoma

Question 2

What is the clinical presentation and what distinct features are there between duodenal and gastric ulcers

Answer 2

1. Epigastric pain, radiating to the back
2. Nausea and vomiting
3. Weight loss/ gain

Distinct features

1. Duodenal ulcers are alleviated by food or antacids and hence weight gain
2. Gastric ulcers are made worse by food and hence weight loss

Question 3

What are complications of PUD

Answer 3

1. Perforation
2. Bleeding
3. Stomach outlet obstruction
4. Penetration ( duodenal penetrating the pancreas)
5. Carcinoma, common in gastric

Question 4

Which ulcers must be biopsied to exclude malignancy

Answer 4

Gastric ulcers

Question 5

How can H.pylori be diagnosed

Answer 5

1. Antral biopsies taken to exclude malignancy
2. Serology
3. Breath tests

Question 6

Indications for excluding Zollinger Ellison syndrome by measuring gastrin levels

Answer 6

1. Patients that need PUD surgery
2. Pts that are treated medical with following associations : diarrhoea, recurrent ulcers, multiple ulcers,atypical situated ulcers ,PU refractory to tx , hypertrophic gastric mucosa on endoscopy

Question 7

Indications for PUD surgery

Answer 7

1. Non- healing ulcers
2. Complications : rare ones being bile duct strictures with obstructive jaundice and Fistulation into adjacent organs I.e gastro-colic fistula