Peptic Ulcer Disease Flashcards
What is peptic ulcer disease?
Breach in the GI mucosa in the stomach/duodenum as a result of acid and pepsin attack. The ulcers have fibrous base and there is an increase in inflammatory cells
What can peptic ulcers be confused with?
Erosions
-superficial breaks in the mucosa alone
Where are gastric ulcers most commonly located?
Lesser curvature of the stomach
Where are duodenal ulcers most commonly located?
Duodenal cap
Who gets peptic ulcer disease?
- Lower socioeconomic groups
- XS acid in duodenum = gastric metaplasia and lead to H.Pylori
- NSAIDs also a common cause
How does peptic ulcer disease present?
- Recurrent burning epigastric pain
- Anorexia and wt loss
- Persistent and severe pain
- Back pain
- Ulcer bleeding or perforation causing haematemesis (coffee ground)
- Epigastric tenderness
- Nocturnal
- Aggravated or relieved eating
- Relapsing and remitting chronic illness
- Dyspepsia
How are peptic ulcers diagnosed?
-Endoscopy
During endoscopy they do a CLO test (rapid urease) to check for H. Pylori
-Biopsy should be considered to rule out malignancy
How is peptic ulcer disease treated?
(Same as GORD)
- PPI
- Tested for H. Pylori, if +ve= eradicate + confirm, if -ve=anti-secretory therapy (PPI)
- Withdraw NSAIDs
- Surgery (only if recurrent uncontrolled haemorrhage)
- GU should be followed up with endoscopy
Complications of peptic ulcer disease?
- Perforation = resulting in acute abdo & peritonitis
- Penetration
- Haemorrhage
- Pyloric Stenosis
- Scarring and strictures of muscle/mucosa leading to PS
Main presentation of stenosis?
- Vomiting is the main presentation (espesh after eating)
- succusion splash on examination
- Anaemia
- Upper abdo pain
- Distension
- Surgery complications (recurring ulcers, diarrhoea, nutritional complications
Treatment of stenosis?
Endoscopic dilation and gastric drainage
Pathophysiology of peptic ulcers?
Breakdown of protective layer of stomach and duodenum
Increase in stomach acid
What is the protective layer in the stomach made up of ?
Mucous and bicarbonate secreted by stomach mucosa
What can the protective layer in the stomach be broken down by?
Medications: steroids/NSAIDs
H. pylori
What can increased acid result from?
Stress Alcohol Caffeine Smoking Spicy foods
