Peptic ulcer disease & gastritis Flashcards
Define peptic ulcer disease
Ulceration of areas of the GI tract caused by exposure to gastric acid & pepsin
Locations of ulcers
2 common + 2 other
Gastric & duodenal
Can also occur in oesophagus & Meckel’s diverticulum
Aetiology of peptic ulcer disease
Caused by an imbalance between the damaging action of acid/pepsin & the mucosal protective mechanisms
Causes of peptic ulcers
2 + rare
Helicobacter pylori
NSAIDs
Zollinger-Ellison syndrome
Epidemiology of peptic ulcer disease
prevalence, gender, ages x2
Common
More common in males
Mean age:
Duodenal ulcers - 30s
Gastric ulcers - 50s
Presenting symptoms of peptic ulcer disease
2.5
Epigastric pain
Relieved by antacids
May present with complications (e.e. haematemesis, melaena)
Relationship of symptoms to food intake - gastric & duodenal ulcers
Gastric - pain worse soon after eating
Duodenal - pain is worse several hours after eating
Signs of peptic ulcer disease on physical examination
1 + 2
May be NO physical findings
Epigastric tenderness
Signs of complications (e.g. anaemia)
Investigations for peptic ulcer disease
4
Bloods
Endoscopy
Testing for H. pylori
Rockall scoring
Blood tests for peptic ulcer disease
7
FBC Serum amylase U&Es Clotting screen LFT Cross match if active bleeding Secretin test (if Zollinger-Ellison syndrome suspected)
Reason for endoscopy
1 + 1
To take biopsies of gastric ulcers to rule out malignancy
Duodenal ulcers do NOT need to be biopsied
Definition of Rockall scoring & meaning
Scores the severity after a GI bleed
<3 is good prognosis, >8 is hight risk of mortality
H. pylori tests
3
C13-urea breath test
Serology (IgG antibody)
Campylobacter-like organism (CLO) test
Management of peptic ulcers
4
Acute
Endoscopy
Surgery
H. pylori eradication
Management of peptic ulcers - ACUTE
4
Fluid resuscitation needed if ulcer is perforated or bleeding (IV colloids/crystalloids)
Close monitoring of vital signs
Endoscopy
Surgical treatment
Management of peptic ulcers - ENDOSCOPY
3
If ulcer is bleeding, haemostasis can be achieved by:
- injection sclerotherapy
- laser coagulation
- electrocoagulation
Management of peptic ulcers - SURGERY
1
Indicated if the ulcer has perforated or if the bleeding ulcer can’t be controlled
Management of peptic ulcers - H. PYLORI
2 + 3
H. pylori eradication
Triple therapy for 1-2 weeks
Usually 2 antibiotics + PPI (e.g. clarithromycin + amoxicillin + omeprazole)
If peptic ulcer is NOT associated with H. pylori:
Treat with PPIs or H2 antagonists
Stop NSAID use
Use misoprostol if NSAID use necessary
Major complications of peptic ulcer disease
% annually + 3
1% major complications per year
Major complications -
Haemorrhage
Perforation
Obstruction/pyloric stenosis
Prognosis for peptic ulcer disease
2
10% overall lifetime risk
Generally good as H. pylori can be cured by eradication
