peptic ulcer disease

Question 1

define peptic ulcer disease?

Answer 1

ulceration of areas of the GI tract caused by exposure to gastric acid and pepsin.

Question 2

what is the cause of peptic ulcer disease?
common cause
rare cause

Answer 2

it is caused by an imbalance between the damaging action of acid and pepsin and the protective mucus
common cause - H. Pylori and NSAID use
rare cause - zollinger- Ellison syndrome

Question 3

epidemiology of peptic ulcer disease?

Answer 3

it is common 
more common in males 
duodenal ulcers are common in the 30s 
gastric ulcers are common in the 50s 
H. pylori infection is often acquired during childhood

Question 4

presenting complaint of peptic ulcer disease?

Answer 4

epigastric abdominal pain

• if symptoms are worse STRAIGHT after eating then it might be gastric ulcers
• if symptoms are worse a WHILE after eating it might be duodenal ulcers

Question 5

what are the signs of peptic ulcer disease after examination?

Answer 5

• epigastric tenderness

- there might be no physical symptoms

Question 6

what bloods should be taken for peptic ulcer disease?

Answer 6

• FBC (checks for anaemia)
• amylase (excludes pancreatitis)
• Us and Es
• clotting screen
• LFT
• secretin test ( for zollinger- Ellison syndrome)

Question 7

what might an endoscopy exclude?

Answer 7

• rules out malignancy

Question 8

how to assess a GI bleed?

Answer 8

• using Rockall scoring
• less than 3 is good prognosis
• greater than 8 is high risk of mortality

Question 9

how to test for H. Pylori?

Answer 9

• 13 C urea breath test
  give the patient radio-labelled urea by mouth and detect 13C in the expired air
• IgG antibody test against H. Pylori
• Stool antigen test (colour change is yellow to red)

Question 10

how is peptic ulcer disease acutely managed conservatively?

Answer 10

• resuscitation if the ulcer bleeds along with monitorring of vital signs
• followed by endoscopic or surgical treatment
• patients with upper GI bleeding can be treated with IV PPIs at presentation
• IV PPIs should be continued until risk of bleeding is over

Question 11

how is peptic ulcer disease acutely managed endoscopically?

Answer 11

• haemostasis is managed by injection sclerotherapy

Question 12

when does the peptic ulcer need to be dealt with surgically ?

Answer 12

• if the perforated or ulcer related bleeding cannot be controlled then surgery is needed

Question 13

how can H pylori be eradicated?

Answer 13

• H. pylori can be eradicated with triple therapy for 1-2 weeks
• one PPI and two antibiotics

Question 14

if the peptic ulcer disease is not associated with H. pylori then how should the patient be managed in the future?

Answer 14

• treat with PPIs or H2 antagonists
• stop NSAID use replace with misoprostol
  (prostaglandin E1 analogue)

Question 15

what are complications of peptic ulcer disease?

Answer 15

• haemorrhage
• perforation
• obstruction

Question 16

what is the prognosis?

Answer 16

• good prognosis