Peptic ulcer disease/Gastritis

Question 1

Define:

Answer 1

Ulceration of area of the GI tract due to exposure to gastric acid and pepsin (usually duodenal and gastric)

Gastritis is the inflammation of the gastric mucosa.

Question 2

Aetiology/risk factors:

Answer 2

Due to an imbalance of acid and protective mucosa.
H.pylori
NSAIDS
Smoking 
Shift workers (skip breakfast)
Alcohol 

RARE - Zollinger Ellison syndrome (gastrin secreting tumour or hyperplasia of the islet cells of the pancreas)

Gastritis can also be autoimmune so family history.

Question 3

Symptoms:

Answer 3

Epigastric pain

Gastric ulcers are worse immediately after food (weight loss)

Duodenal ulcers are worse a while after food (weight gain)

Question 4

Signs:

Answer 4

None usually but can have epigastric tenderness

Question 5

investigations:

Answer 5

if <55 and no red flags - H.pylori breath/stool test, FBC and serum gastrin.

If >55 and red flags - Upper GI endoscopy and biopsy. If there are ulcers rescope in 6-8 weeks as you worry about malignancy

Bloods - U+E’s, LFTS, amylase (rule out pancreatitis), clotting screen, secretin test (Zollinger-Ellison syndrome)

Campylobacter like test (yellow to red = positive)

Question 6

management:

Answer 6

If bleeding - iv fluids and DRS ABC, monitor vital signs

Endoscopy - if bleeding - sclerotherapy and electro/laser coagulation.

Surgical - if the ulcer bleeds or perforates.

H.pylori (PPI such as omeprazole + amoxicillin and clarithromycin)

Non-H.pylori - PPI and H2 antagonist as well as stop NSAID, smoking and drinking.

Question 7

complications:

Answer 7

haemorrhage if bleeds
perforation
obstruction/pyloric stenosis (due to scarring)

Question 8

prognosis

Answer 8

10% lifetime risk