Peptic Ulcer Disease

Question 1

where does peptic ulcer disease occur?

Answer 1

any acid affected site e.g. oesophagus, stomach, duodenum

Question 2

what is the cause of peptic ulcer disease in the duodenum?

Answer 2

high acid secretion which duodenum alkali secretions cannot neutralise

Question 3

what is the cause of stomach disease in the duodenum?

Answer 3

there is normal acid secretion but the stomach loses the ability to defend against attack

Question 4

what drugs cause peptic ulcer disease?

Answer 4

NSAIDs and steroids

Question 5

what is a peptic ulcer?

Answer 5

a deep burn into the tissue which can erode into an artery or straight through into the peritoneum

Question 6

what is a perforated ulcer?

Answer 6

when a peptic ulcer erodes straight through into the peritoneum

Question 7

if there is excessive acid where do peptic ulcers occur?

Answer 7

oesophagus and duodenum

Question 8

if there is normal acid secretion how do peptic ulcers occur?

Answer 8

reduced protective barrier, helicobacter pylori involvement

Question 9

what does helicobacter pylori do?

Answer 9

causes loss of mucous barrier which allows stomach acid to get out the gastrin wall and cause peptic ulceration, removes protective mucous

Question 10

what are the effects of helicobacter pylori?

Answer 10

gastric ulcers and chronic gastric wall inflammation

Question 11

how do you eliminate helicobacter pylori?

Answer 11

with triple therapy - 2 antibiotics and 1 proton pump inhibitor

Question 12

what are the signs and symptoms of peptic ulcer disease?

Answer 12

asymptomatic OR epigastric burning pain worse before/after meals/at night

Question 13

what are the investigations for peptic ulcer disease?

Answer 13

endoscopy, radiology, anaemia, H pylori breath/antibodies/mucosa test

Question 14

what are the local complications of peptic ulcer disease?

Answer 14

perforation, haemorrhage, stricture, malignancy

Question 15

what is the systemic complication of peptic ulcer disease?

Answer 15

anaemia

Question 16

what are the medical treatments for peptic ulcer disease?

Answer 16

stop smoking, small regular meals, eradication therapy, ulcer healing drugs

Question 17

when are medical treatments used for peptic ulcer disease?

Answer 17

when the problem is reversible, when lifestyle changes will work, when H. pylori is present

Question 18

when are surgical treatments used for peptic ulcer disease?

Answer 18

when there is stricture, acute bleeding, perforation, malignancy

Question 19

what surgical procedures are used for treatment of peptic ulcer disease?

Answer 19

endoscopy, surgical repair (gastrectomy), vagotomy

Question 20

what medication is used for peptic ulcer disease?

Answer 20

H2 receptor blockers, proton pump inhibitors

Question 21

what are the aims in medicating for peptic ulcer disease?

Answer 21

reduce acid secretion and improve mucosal barrier

Question 22

how do you improve the mucosal barrier of the stomach?

Answer 22

eliminate helicobacter, inhibit prostaglandin removal

Question 23

which antibiotics and proton pump inhibitor are used to eliminate helicobacter pylori and for how long?

Answer 23

amoxycillin, metronidazole and omeprazole for 2 weeks

Question 24

what is the surgery called for peptic ulcer disease?

Answer 24

bilroth 1/2 and vagotomy

Question 25

describe bilroth 1

Answer 25

excision of part of stomach containing ulcers, anastomosis of duodenum to remaining part of stomach, no sphincter so food flows freely which causes problems for patients

Question 26

what is the procedure for bilroth 2

Answer 26

same as bilroth 1 but the joining goes further into the duodenum which can be better for some patients

Question 27

what happens with a vagotomy?

Answer 27

divide small branches from main vagal trunk so acid secretion is controlled by reduced neural control