Peptic Ulcer Disease and malabsorption

Question 1

Define peptic ulcer

Answer 1

A break in the mucosal lining of the stomach or duodenum more than 5mm in diameter with depth to the submucosa

Question 2

Epidemiology of peptic ulcer disease

Answer 2

• 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

Question 3

Two types of peptic ulcers and which is more common

Answer 3

Gastric ulcer
Duodenal - most common

Question 4

Causes of peptic ulcers

Answer 4

Anything that decreases mucosal production or increases acid production

Question 5

What can cause a decrease in mucosa production and an increase in acid production

Answer 5

Gastritis
H pylori
Nsaids
Smokign
Caffeine

Question 6

How would h pylori infection cause peptic ulcer disease

Answer 6

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

Question 7

How do NSAIDs cause peptic ulcer disease

Answer 7

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

Question 8

Disease pathway for gastric cancer

Answer 8

Gastritis
Peptic ulcer disease
Gastric adenocarcinoma

Question 9

Signs and symptoms of peptic ulcer disease

Answer 9

Dyspepsia
Epogastric pain
N&V
Perforation of artery - haematemesis

Question 10

Investigations for PUD if no active bleeding

Answer 10

H pylori tests - Urea breath test + Stool antigen test
Upper GIEndoscopy and biopsy GOLD

Question 11

Investigations if there is active bleeding

Answer 11

FBC
UEs
LFTs
VBG

Question 12

DDs of peptic ulcers

Answer 12

• GORD
• Non-ulcer dyspepsia
• Gastritis

Question 13

Why does a duodenal ulcer get better after eating

Answer 13

The pyloric sphincter will close after eating , hence no acid goes through , thus less pain

Question 14

Where do gastric ulcer and duodenal ulcers form?

Answer 14

• 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

Question 15

What arteries are perforated in gastric and duodenal ulcers

Answer 15

• Gastric ulcers typically affect the left gastric artery
• Duodenal ulcers typically affect the gastroduodenal artery

Question 16

Signs after perforation of each type of ulcer

Answer 16

Gastric - haematamesis + melena
Duodena - melena and haematochezia

Question 17

What happens to duodenal and gastric ulcers after eating

Answer 17

Duodenal gets better after food
Gastric gets worse after food

Question 18

Treatment for peptic ulcer disease if no bleeding

Answer 18

Treat underlying cause
Stop nsaids
Triple therapy - H pylori positive
Reduce smoking and alcohol
H pylori negative - PPI

Question 19

Treatment for peptic ulcer disease with active bleeding

Answer 19

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

Question 20

Complications of PUD

Answer 20

• 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

Question 21

what may someone present with if they have malabsoprtion

Answer 21

anaemia
weight loss
smelly poo

Question 22

what are crypts

Answer 22

where bowel cells produce new cells to replace old cells at the top of villi

Question 23

what can cause malabsorption

Answer 23

• insufficient intake
• defective intraluminal digestion
• insufficient absorptive area
• lack of digestive enzymes
• defective epithelial transport

Question 24

what happens indefective intraluminal digestion

Answer 24

pancreatic insufficiency:
- pancreatitis
- cystic fibrosis

Defective bile secretion (lack of fat solubilization)
- biliary obstruction
- ileal resection - decreased bile salt uptake

Bacterial overgrowth

Question 25

What does Giardia lamblia do?

Answer 25

Decreases surface area of the villi so less food can be absorbed

Question 26

What happens in small intestinal resection or bypass

Answer 26

For morbid obesity
Crohn’s disease
Infarcted small bowel