Peptic Ulcer Disease and malabsorption Flashcards
Define peptic ulcer
A break in the mucosal lining of the stomach or duodenum more than 5mm in diameter with depth to the submucosa
Epidemiology of peptic ulcer disease
- M>F
- Estimated lifetime prevalence for men estimated at 11–20% and for women at 8–11%
- More common with increasing age
- More common in developing countries due to Helicobacter pylori
Two types of peptic ulcers and which is more common
Gastric ulcer
Duodenal - most common
Causes of peptic ulcers
Anything that decreases mucosal production or increases acid production
What can cause a decrease in mucosa production and an increase in acid production
Gastritis
H pylori
Nsaids
Smokign
Caffeine
How would h pylori infection cause peptic ulcer disease
Secretes urease
Urea is converted to ammonium which is toxic to gastric mucosa
There is a decrease in mucus and an increase in inflammation thus increased acid production
How do NSAIDs cause peptic ulcer disease
inhibit the enzyme cyclooxygenase which is involved in the synthesis of inflammatory prostaglandins. Overtime this leaves the mucosal layer susceptible to damage by ulcer formation.
Prostaglandins normally reduces acid secretion and increases mucus production
Disease pathway for gastric cancer
Gastritis
Peptic ulcer disease
Gastric adenocarcinoma
Signs and symptoms of peptic ulcer disease
Dyspepsia
Epogastric pain
N&V
Perforation of artery - haematemesis
Investigations for PUD if no active bleeding
H pylori tests - Urea breath test + Stool antigen test
Upper GIEndoscopy and biopsy GOLD
Investigations if there is active bleeding
FBC
UEs
LFTs
VBG
DDs of peptic ulcers
- GORD
- Non-ulcer dyspepsia
- Gastritis
Why does a duodenal ulcer get better after eating
The pyloric sphincter will close after eating , hence no acid goes through , thus less pain
Where do gastric ulcer and duodenal ulcers form?
- Gastric ulcers typically form in the lesser curvature of the antrum.
- Duodenal ulcers usually develop right after the pyloric sphincter and there’s usually Brunner gland hypertrophy
What arteries are perforated in gastric and duodenal ulcers
- Gastric ulcers typically affect the left gastric artery
- Duodenal ulcers typically affect the gastroduodenal artery
Signs after perforation of each type of ulcer
Gastric - haematamesis + melena
Duodena - melena and haematochezia
What happens to duodenal and gastric ulcers after eating
Duodenal gets better after food
Gastric gets worse after food
Treatment for peptic ulcer disease if no bleeding
Treat underlying cause
Stop nsaids
Triple therapy - H pylori positive
Reduce smoking and alcohol
H pylori negative - PPI
Treatment for peptic ulcer disease with active bleeding
First-line:
- IV crystalloid
- Blood transfusion: if significant acute blood loss suspected
- Upper GI endoscopy
Second line:
- Surgery or embolisation (blocking abnormal vessels) by interventional radiolog
Complications of PUD
- Perforation: life-threatening as ulcer penetrates the duodenum or stomach into the peritoneal cavity causing peritonitis. May also allow air to collect under the diaphragm and irritate the phrenic nerve causing referred shoulder pain. Requires surgical intervention!
- Gastric outlet obstruction/ pyloric stenosis: caused by obstruction of the pylorus due to an ulcer and subsequent scarring. Presents with abdominal pain, distension, vomiting and nausea after eating
what may someone present with if they have malabsoprtion
anaemia
weight loss
smelly poo
what are crypts
where bowel cells produce new cells to replace old cells at the top of villi
what can cause malabsorption
- insufficient intake
- defective intraluminal digestion
- insufficient absorptive area
- lack of digestive enzymes
- defective epithelial transport
what happens indefective intraluminal digestion
pancreatic insufficiency:
- pancreatitis
- cystic fibrosis
Defective bile secretion (lack of fat solubilization)
- biliary obstruction
- ileal resection - decreased bile salt uptake
Bacterial overgrowth
What does Giardia lamblia do?
Decreases surface area of the villi so less food can be absorbed
What happens in small intestinal resection or bypass
For morbid obesity
Crohn’s disease
Infarcted small bowel
