Peptic ulcer disease and gastritis Flashcards
What is peptic ulcer disease?
Ulceration of areas of the GI tract caused by exposure to gastric acid and pepsin (protease).
Where does peptic ulcer disease manifest? (x4)
Most commonly gastric and duodenal, but also in oesophagus and Meckel’s diverticulum.
What is the aetiology of peptic ulcer disease?
Cause is an imbalance between damaging action of acid and pepsin and mucosal protective mechanisms.
What are the risk factors of peptic ulcer disease? (x2, x3, x3)
o Commonly H. pylori (present in 95% of duodenal ulcers and 70-80% of gastric ulcers), NSAID use.
o DUODENAL-SPECIFIC: Rarely smoking, increased gastric acid secretion, Zollinger-Ellison syndrome (gastrinomas in duodenum pancreas – gastrin production stimulates gastric acid production)
o GASTRIC-SPECIFIC: reflux of duodenal contents, stress, Cushing’s ulcers.
What are Cushing’s ulcers?
Gastric ulcer arising from high intracranial pressure. Mechanism is thought to be that increased intracranial pressure stimulates the vagus nerve which increased gastric acid secretion.
What is the most common location for duodenal ulcers and why?
Duodenal cap (first part of duodenum), as this is where acid enters the duodenum prior to addition of alkaline which neutralises it.
What is the most common location for stomach ulcers and why?
Antrum because this is where gastric epithelium begins to transition to duodenal epithelium which is less robust to damage.
What is the epidemiology of peptic ulcer disease: Incidence? Gender? Age? (x2) Prevalence and age? Difference between duodenal and gastric ulcer incidence?
Common with annual incidence of 1-4/1000. More common in males. Duodenal ulcers have a mean age of 30s, while gastric ulcers are 50s. Prevalence if roughly equivalent to age in years. Duodenal 4-fold more common than gastric ulcer.
What are the symptoms of peptic ulcer disease? (x3)
- Epigastric abdominal pain, burning and dull, relieved by antacids. Some will describe it as heartburn.
- ALARM symptoms: anaemia (arising as a complication), loss of weight, anorexia, recent onset/progressive symptoms, melaena/haematemesis (as a complication), swallowing difficulty (dysphagia).
- Vomiting
How does epigastric pain change according to food intake in peptic ulcer disease? (x2)
If worse soon after eating, more likely to be gastric ulcers. If worse several hours later and relieved on eating, more likely to be duodenal.
What are the complications of peptic ulcer disease? (x3 categories)
o Haemorrhage: haematemesis, melaena, iron-deficiency anaemia
o Perforation
o Obstruction or pyloric stenosis due to scarring, penetration or pancreatitis
What are the signs of peptic ulcer disease? (x3)
o May be no physical findings
o Epigastric tenderness
o Signs of anaemia
o Succession splash in pyloric stenosis
What is succession splash in pyloric stenosis?
A succussion splash, also known as a gastric splash, is a sloshing sound heard through a stethoscope during sudden movement of the patient on abdominal auscultation. It reflects the presence of gas and fluid in an obstructed organ.
What are the investigations for peptic ulcer disease? (x5)
o BLOODS: FBC (for anaemia), amylase (to exclude pancreatitis), U&Es, clotting screen (if GI bleeding), LFTs, Secretin test (if Zollinger-Ellison syndrome is suspected).
o ENDOSCOPY: gold standard for visualisation of ulcer and carrying out further tests.
o BARIUM MEAL X-RAY: look at photo.
o ROCKALL SCORING: for severity after a GI bleed. Less than 3 carries a good prognosis; more than 8 means high risk of mortality.
o TESTING FOR H. PYLORI.
What can be tested with endoscopy in peptic ulcer disease? (x2)
Four quadrant gastric ulcer biopsies to rule our malignancy. Biopsy of ulcer rim and base for H. pylori histology.
SUMMARY: What are the differentials for dyspepsia?
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