Peptic Ulcer Disease And Gastritis Flashcards
Define Peptic Ulcer Disease and Gastritis?
Ulceration of areas of the GI tract caused by exposure to gastric acid and pepsin
Peptic Ulcers are more commonly gastric and duodenal (but they can also occur in the oesophagus and Meckel’s diverticulum)
What is the aetiology of Peptic Ulcer Disease and Gastritis?
Caused by imbalance between the damaging action of acid and pepsin penis and the mucosal protective mechanisms
There is a strong correlation with H.Pylori
What are the common causes of Peptic Ulcer Disease and Gastritis?
H. Pylori
NSAIDs
What is a Rare cause of Peptic Ulcer Disease and Gastritis?
Zollinger-Ellison Syndrome
What is Zollinger-Ellison Syndrome?
A condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas cause overproduction of gastric acid, resulting in recurrent peptic ulcers
What is the epidemiology of Peptic Ulcer Disease and Gastritis?
COMMON Annual incidence: 1-4/1000 More common in males Mean age: Duodenal Ulcer: 30s Gastric Ulcers: 50s H.Pylori is usually acquired in childhood and prevalence is roughly equal to age in years
What are the presenting symptoms of Peptic Ulcer Disease and Gastritis?
Epigastric pain
Relieved by antacids
Patients may present with complications e.g. haematemesis, melaena
What is the relationship between symptoms of Peptic Ulcer Disease and Gastritis and food intake?
Gastric - pain is worse soon after eating
Duodenal - pain is worse several hours after eating
What are the signs of Peptic Ulcer Disease and Gastritis on physical examination?
There may be NO physical findings
Epigastric tenderness
Signs of complications e.g. anaemia
What bloods would you do for Peptic Ulcer Disease and Gastritis?
FBC Serum Amylase U&Es Clotting screen LFT Cross-match Secretin test
Why do we do a FBC for Peptic Ulcer Disease and Gastritis?
For anaemia
Why do we do Serum Amylase for Peptic Ulcer Disease and Gastritis?
To exclude pancreatitis
When do we do a Cross-Match in Peptic Ulcer Disease and Gastritis?
If active bleeding
When do we do a Secretin test for Peptic Ulcer Disease and Gastritis?
If Zollinger-Ellison syndrome suspected
How does the Secretin Test work?
IV secretin causes a rise in serum gastrin in ZE patients but not in normal patients
Why do we do Endoscopy for Peptic Ulcer Disease and Gastritis?
Biopsies of gastric ulcers can be taken to rule out malignancy
Duodenal ulcers don’t need to be biopsied
What is the Rockall Scoring?
Scores the severity after a GI bleed
How does Rockall scoring work?
Score < 3 carries good prognosis
Score > 8 carries high risk of mortality
What are the three ways of testing H. Pylori?
C13-urea breath test
Serology
Campylobacter-like organism (CLO) test
How does the C13-urea breath test work?
Radio-labelled urea is given by mouth
C13 is detected in the expelled air
How can we use Serology to test for H.Pylori?
IgG antibody against H.Pylori confirms exposure to H.Pylori but NOT eradication
What is the Campylobacter-like organism (CLO) test?
Gastric biopsy is placed with a substrate of urea and a pH indicator
If H.Pylori is present, ammonia is produced from the urea and there is a colour change from yellow to red
What is the acute management plan for Peptic Ulcer Disease and Gastritis?
Fluid resuscitation needed if the ulcer is perforated or bleeding (IV colloids/crystalloids)
Close monitoring of vital signs
Endoscopy
Surgical treatment
How should patients with upper GI bleeding be treated?
IV PPIs at presentation until the cause of bleeding is identified
How can Endoscopy be used to manage Peptic Ulcer Disease and Gastritis?
IF the ulcer is bleeding, haemostasis can be achieved with:
- Injection sclerotherapy
- Laser coagulation
- Electrocoagulation
When do we perform surgery for Peptic Ulcer Disease and Gastritis?
Indicated if the ulcer has perforated or if the bleeding ulcer can’t be controlled
How do we eradicate H.Pylori in Peptic Ulcer Disease and Gastritis?
Triple therapy for 1-2 weeks
Various combinations may be recommended - usually a combination of 2 antibiotics + PPI (e.g. clarithromycin + amoxicillin + omeprazole)
What do we do if Peptic Ulcer Disease is not associated with H.Pylori?
Treat with PPIs or H2 antagonists
Stop NSAID use
Use misoprostal (prostoglandin E1analogue) if NSAID use is necessary
What is the rate of major complications of Peptic Ulcer Disease and Gastritis?
1% per year
What are the major complications of Peptic Ulcer Disease and Gastritis?
Haemorrhage (haematemesis, melaena, iron-deficiency anaemia)
Perforation
Obstruction/pyloric stenosis (due to scarring, penetration, pancreatitis)
What is the prognosis for patients with Peptic Ulcer Disease and Gastritis?
Overall lifetime risk = 10%
Outlook is generally good because peptic ulcers associated with H.Pylori can be cured by eradication
