Peptic Ulcer Disease

Question 1

Risk factors

Answer 1

Acute: Stress and Drugs - NSAIDs, steroids, SSRI, bisphosphonates

Chronic: H.pylori, Zollinger Ellison syndrome

Question 2

Pathophysiology

Answer 2

Increased pH causes breach of the mucosa to the muscularis mucosa

Question 3

Symptoms

Answer 3

Burning epigastric pain
Nausea and vomiting
May get haematemesis or maleana
Anaemia - lethargy

Question 4

Signs

Answer 4

Pallor
Epigastric tenderness
Melaena - on PR examination
Hypovalaemic Shock - tachycardia and tachypnoea

Question 5

Commonest ulcers

Answer 5

Gastroduodenal - 80%

Gastric - 20%

Question 6

Difference between gastroduodenal and peptic ulcer

Answer 6

Peptic ulcer - worse after eating

Duodenal ulcer - Worse before meals and relieved by eating

Question 7

Zollinger Ellison syndrome

Answer 7

Excessive levels of gastrin

Question 8

Investigations

Answer 8

Abdominal examination 
Obs 
Bloods - FBC, U+Es, LFTs, CRP 
Stool antigen test or urease breath test - before PPI given 
Gastrin levels - Zollinger

If older than 55 yo - OGD and biopsy to exclude malignancy (PPI stopped 2 wks prior)

Glasgow blatchford score
Rockfall score

Question 9

H.pylori action

Answer 9

Secretes urease which converts urea to ammonia which is cytotoxic

Question 10

How to diagnose H.pylori

Answer 10

Stool antigen test

Urease breath test

Question 11

Management for H.pylori

Answer 11

Amoxicillin + PPI + Clarithromycin

If penicillin resistance

Clarithromycin + metronidazole + PPI

Question 12

Management for NSAID induced

Answer 12

Stop NSAID

Give high dose PPI

Question 13

How to investigate Zollinger Ellison syndrome

Answer 13

Fasting gastrin level

Question 14

Why is urea raised in upper GI bleed

Answer 14

Blood has high protein content and is digested

Question 15

Coffee ground vomitus

Answer 15

Indicates coagulated blood - haematemisis

Question 16

Upper GI bleed scoring system

Answer 16

Glasgow Blatchford score
- 1+ pt requires admission for inpatient endoscopy

Rockfall score

• risk of adverse outcomes FOLLOWING endoscopic treatment
• done after endoscopy

Question 17

Management if haemodynamically unstable

Answer 17

Mechanical - clipping +/- adrenaline

Or

Thermal coagulation + adrenaline

Or

Sclerotherapy + adrenaline

• High dose IV PPI after endoscopy

Question 18

Complications

Answer 18

Haemorrhage:

• Haematemeis or melaena
• Fe deficiency anaemia

Perforation:
- Peritonitis

Gastric Outflow Obstruction
- Vomiting, colic, distension

Malignancy
- ↑ risk with H. pylori

Question 19

Which test is used to check if H. Pylori has been successfully eradicated at follow up

Answer 19

OGD
Urease breath test - highest specificity

After 6 - 8 weeks

Question 20

Which medication must be stoped before H. Pylori test

Answer 20

PPI 2 weeks prior to test and antibiotics 4 weeks prior

Question 21

Ulcers at the gastroduodenal junction run the risk of eroding into what vessel?

Answer 21

Common hepatic artery - branches to gastroduodenal artery

Question 22

Risk factors for upper GI bleeds

Answer 22

NSAIDS 
Steroids 
Bisphosphonates 
Anticoagulants 
Smoking 
alcohol