Peptic Ulcer Disease Flashcards
where does peptic ulcer disease occur?
any acid affected site e.g. oesophagus, stomach, duodenum
what is the cause of peptic ulcer disease in the duodenum?
high acid secretion which duodenum alkali secretions cannot neutralise
what is the cause of stomach disease in the duodenum?
there is normal acid secretion but the stomach loses the ability to defend against attack
what drugs cause peptic ulcer disease?
NSAIDs and steroids
what is a peptic ulcer?
a deep burn into the tissue which can erode into an artery or straight through into the peritoneum
what is a perforated ulcer?
when a peptic ulcer erodes straight through into the peritoneum
if there is excessive acid where do peptic ulcers occur?
oesophagus and duodenum
if there is normal acid secretion how do peptic ulcers occur?
reduced protective barrier, helicobacter pylori involvement
what does helicobacter pylori do?
causes loss of mucous barrier which allows stomach acid to get out the gastrin wall and cause peptic ulceration, removes protective mucous
what are the effects of helicobacter pylori?
gastric ulcers and chronic gastric wall inflammation
how do you eliminate helicobacter pylori?
with triple therapy - 2 antibiotics and 1 proton pump inhibitor
what are the signs and symptoms of peptic ulcer disease?
asymptomatic OR epigastric burning pain worse before/after meals/at night
what are the investigations for peptic ulcer disease?
endoscopy, radiology, anaemia, H pylori breath/antibodies/mucosa test
what are the local complications of peptic ulcer disease?
perforation, haemorrhage, stricture, malignancy
what is the systemic complication of peptic ulcer disease?
anaemia
what are the medical treatments for peptic ulcer disease?
stop smoking, small regular meals, eradication therapy, ulcer healing drugs
when are medical treatments used for peptic ulcer disease?
when the problem is reversible, when lifestyle changes will work, when H. pylori is present
when are surgical treatments used for peptic ulcer disease?
when there is stricture, acute bleeding, perforation, malignancy
what surgical procedures are used for treatment of peptic ulcer disease?
endoscopy, surgical repair (gastrectomy), vagotomy
what medication is used for peptic ulcer disease?
H2 receptor blockers, proton pump inhibitors
what are the aims in medicating for peptic ulcer disease?
reduce acid secretion and improve mucosal barrier
how do you improve the mucosal barrier of the stomach?
eliminate helicobacter, inhibit prostaglandin removal
which antibiotics and proton pump inhibitor are used to eliminate helicobacter pylori and for how long?
amoxycillin, metronidazole and omeprazole for 2 weeks
what is the surgery called for peptic ulcer disease?
bilroth 1/2 and vagotomy
describe bilroth 1
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
what is the procedure for bilroth 2
same as bilroth 1 but the joining goes further into the duodenum which can be better for some patients
what happens with a vagotomy?
divide small branches from main vagal trunk so acid secretion is controlled by reduced neural control
