Peptic Ulcer Disease Flashcards
Where in the GI tract can peptic ulcer disease occur?
- Any acid affected site
- oesophagus
- stomach
- duodenum
What are the causes of PUD?
- High acid secretion - duodenal
- Normal acid secretion - stomach (loses ability to defend from acid attack
- can be due to some drugs (NSAIDS, steroids)
Why can normal acid production result in peptic ulcer disease?
- Reduced protective barrier
- Helicobacter pylori involvement
- causes loss of the mucus barrier
- allows acid in the stomach to attack the gastric wall, causing peptic ulceration
What are the main effects of helicobacter pylori bacteria?
- Gastric ulcers
- Chronic gastric wall inflammation
- lymphoma of the stomach
What is the best way to eliminate Helicobacter pylori?
- eliminate with triple therapy
- 2 antibiotics
- 1 proton pump inhibitor
What are PUD signs and symptoms?
- Often asymptomatic
- Epigastric burning pain
- worse before/just after meals
- worse at night
- relieved by food, alkali and vomiting - Usually no physical signs
- only when complication e.g. bleeding, perforations
What are common PUD investigations?
- Endoscopy
- oesophagus, stomach and duodenum - Radiology
- barium meal - Anaemia
- F.B.C and faecal occult blood test (FOB’s) - H. Pylori - breath, antibodies, mucosa
What are local and systemic PUD complications?
- Local
- perforation
- haemorrhage (vessel will not coagulate properly due to acid irritation)
- stricture (chronic irritation results in a scar that can reduce the size of the exit of the stomach)
- malignancy
- Systemic
- anaemia - peritonitis
- caused by perforation
What are medical PUD treatments?
- Medical issues
- reversible problem
- lifestyle changes
- H. Pylori present
Solutions:
- stop smoking
- small regular meals
- eradication therapy
- ulcer healing drugs
What are surgical PUD treatments
- Surgical issues
- stricture
- acute bleed
- perforation
- malignancy
Solutions:
- endoscope
- surgical repair (gastrectomy)
- vagotomy (dividing vagus nerve branches to stomach, preventing acid secretion)
What other methods apart from neutralising acid and reducing acid secretion can be used to treat upper GI disease?
Improve mucosal barrier - eliminate helicobacter - inhibit prostaglandin removal . NSAID use encourages this - avoid . Reduce steroid use
What drugs are often used in triple therapy to help remove H.pylori?
Two week course of
- two antibiotics (amoxycillin, metronidazole)
- proton pump inhibitor (omeprazole)
Describe the PUD surgery, Bilroth 1 procedure
1.Excision of part of the stomach containing ulcers (usually middle)
- Anastomosis is duodenum to remaining part of the stomach
- makes stomach smaller, reducing diet
- no sphincter present at duodenum so good flows freely - this can cause problems in some patients
Describe the Bilroth 2 procedure
1.Excision of ulcerated part of stomach (usually middle)
- Anastomosis of remaining stomach to the duodenum, but further down
- causes less problems in some patients
- however the blind loop left behind can cause problems via bacterial proliferation (however pancreatic and biliary secretions still flow into this)
Describe highly selective vagotomy
Dividing small branches from the main vagas trunk passing into the stomach wall results in reduced acid secretion caused by neurological triggers
