Peptic Ulcer Disease Flashcards
What is a peptic ulcer?
A sore or break in the membrane of the stomach or duodenum (more common).
What the the three layers of the gastric mucosa?
Epithelial Layer
Lamina propria
Muscularis mucosa
What are the three regions of the stomach?
Cardia Fundus Body Pyloric antrum (Pyloric sphincter onto duodenum)
What do parietal, chief cells and G cells secrete in the stomach?
Parietal cells - hydrochloric acid
Chief cells - pepsinogen (digests protein)
G cells - Gastrin
What is the function of gastrin?
Stimulates parietal cells to produce hydrochloric acid
What prevents auto-digestion in the stomach?
Mucus and bicarbonate ions (secreted by duodenum)
What are the main causes of peptic ulcers?
H. pylori infection - gram negative bacteria, adhere and damage mucosal cells.
(Affects antrum and duodemum first)
NSAIDS - inhibit enzyme involved in prostaglandin synthesis and cause gastric ulcers (not duodenal)
Zollinger-Ellison syndrome - Gastrinoma tumour typically located duodenum or pancrease - increased HCL secretion (duodenum)
What do gastric ulcers appear as?
Small, punched out holes in the mucosa with a clear base.
Can bleed
Where are peptic ulcers most commonly found?
Gastric ulcer - lesser curvature of antrum
Duodenal - just past pyloric sphincter
What is an emergency complication of gastric ulcers?
Very deep ulcers, bleeding from artery –> Haemorrhage into GI tract and shock.
Perforation - Peritonitis (duodenal ulcers) - refered pain to shoulder
Obstruction at pyloric sphincter due to scarring
What two arteries are most at risk of bleeding from peptic ulcers?
Left gastric artery
Gastroduodenal artery
What are the symptoms of peptic ulcer disease?
Epigastric pain
Bloating
Belching
Vomiting
How does the pain differ between gastric and duodenal ulcers?
Gastric ulcers - pain increased whist eating - associated with weight loss
Duodenal ulcer - pain decreases whist eating - associated with weight gain
How are peptic ulcers diagnosed?
Upper endoscopy with biopsy (h.pylori or malignancy)
What is the treatment of peptic ulcers?
H.pylori - ABx + Anti-acid (PPI)
Remove NSAIDS, Alcohol, Tobacco and caffeine
Surgery may be required
