Peptic Ulcer Disease (PUD) Flashcards
Define peptic ulcer disease.
Ulceration of the mucosa of the stomach of the duodenum.
A peptic ulcer consists of a break in the superficial epithelial cells penetrating down to the muscularis mucosa of either the stomach or the duodenum; there is a fibrous base and an increase in inflammatory cells.
What are the 2 types of peptic ulcers?
- Gastric peptic ulcers
- Duodenal peptic ulcers
Which one is more common?
Duodenal peptic ulcers
Give 3 causes of peptic ulcers.
- Prolonged NSAIDs + Steroid use -> decreased mucin production.
- H.pylori infection.
- Hyper-acidity
- Smoking
- Stress
- Alcohol
What is the stomach mucosa lining prone to?
The stomach mucosa is prone to ulceration from:
- Breakdown of the protective layer of the stomach and duodenum
- Increase in stomach acid
Explain the pathophysiology of PUD caused by NSAIDs.
NSAIDs e.g. Naproxen and Aspirin:
1. Mucous secretion is stimulated by prostaglandins (in inflamed tissue, prostaglandin triggers inflammatory response thus inhibition = less inflammation)
2. Cyclo-oxygenase 1 is needed for prostaglandin synthesis
3. NSAIDS inhibit cylclo-oxygenase 1
4. Thus, reduced mucosal defence
Explain the pathophysiology of PUD caused by a H.pylori infection.
Secretes urease → urea converted to ammonium (is toxic to gastric mucosa) → decreased mucus + increased inflammation → increased acid production.
Secreted proteases, phospholipase & vacuolating cytotoxin A → begin attacking the gastric epithelium → further reducing mucous
production → results in an inflammatory response and less mucosal defence.
Also increases gastrin (released from G cells) release → thereby causing more acid secretion from parietal cells → and also triggering the release of histamine, which further increases acid secretion V Increased acidity overwhelms the protective mucin resulting in mucosal damage and ulceration.
Explain the pathophysiology of peptic ulcers caused by too much acid production.
- Too much acid production:
- Too much acid overwhelms the mucin and results in ulceration
- Stress can result in increased acid production
Give 3 symptoms of peptic ulcers.
Often acute onset of symptoms:
- Dyspepsia (indigestion)
- Recurrent burning epigastric pain.
- Duodenal: gets better after eating
- Gastric: gets worse after eating
- Perforation of artery:
- Haematemesis / melena / “coffee ground” vomiting
-> REALLY BAD
- Haematemesis / melena / “coffee ground” vomiting
- Nausea and weight loss
- Fe-deficient anaemia
Describe dyspepsia seen in peptic ulcers.
- Early satiation
- Severe epigastric pain
- Acidic taste
- Excessive bloating or belching after meals
- Nausea
- Anorexia
What is the impact of eating on gastric and duodenal peptic ulcers?
Duodenal: gets better after eating
Gastric: gets worse after eating
Why are duodenal ulcers less painful after eating?
Duodenal ulcers are less painful after eating because the pyloric sphincter closes during digestion, preventing acid from going into duodenum.
What are the red flag alarm signs for cancer?
RED FLAG ALARM symptoms for CANCER:
* Unexplained weight loss
* Anaemia
* Evidence of GI bleeding e.g. melaena (dark, tar-like, black stools) or haematemesis
* Dysphagia
* Upper abdominal mass
* Persistent vomiting
Outline the disease pathway for peptic ulcers.
Disease pathway:
Gastritis → peptic ulcer → gastric adenocarcinoma (cancer)
What investigations might you do in someone who you suspect to have peptic ulcers?
- Non-invasive testing
- Urease/C-urea breath test
- Faecal antigen test - Endoscopy -> OGD + biopsy - GOLD STANDARD
