Peptic Ulcer Disease (PUD and gastritis) Flashcards
what is a typical presentation of peptic ulcer disease and gastritis?
pain relation to eating and epigastric tenderness gastritis: epigastric pain , bloating and belching
what are the key differences between peptic and duodenal ulcer?
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define peptic ulcer disease?
Break in the epithelium lining of the STOMACH or DUODENUM
what are the causes of peptic ulcer disease and gastritis?
- Helicobacter pylori (chronic) - gram negative flagellate - implicated in 90% of duodenal ulcers and 80% of gastric ulcers.
- NSAIDs (acute) - more commonly causes gastric ulcers - remember to always give PPI with it or ask them to take with meals
- Alcohol (acute)
- Bisphosphonates
- Smoking (acute)
state a rare cause peptic ulcer disease and gastritis?
Zollinger-Ellison syndrome (a condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas cause overproduction of gastric acid, resulting in recurrent peptic ulcers)
To investigate this: fasting serum gastrin is measured and secretin test. To treat: PPI + tumour resection
summarise the epidemiology of peptic ucler disease?
COMMON
Annual incidence: 1-4/1000
More common in males
Mean age: Gastric ulcers: 50s
Helicobacter pylori is usually acquired in childhood and prevalence is roughly equal to age Kin year
what are the presenting symptoms of peptic ulcer disease and gastritis?
Epigastric pain
Relieved by antacids
Symptoms have a variable relationship to food intake:
Gastric - pain is worse soon after eating
Duodenal - pain is worse several hours after eating
Patients may present with complications e.g. haematemesis, melaena
what are the signs of peptic ulcer disease and gastritis on physical examination?
There may be NO physical findings
Epigastric tenderness
Signs of complications e.g. anaemia
what are the appropriate investigations for peptic ulcer disease and gastritis?
If < 55 and no red flags
- H pylori breath test/stool antigen test
- FBC
- Stool occult blood test
- Serum gastrin - zollinger Ellison syndrome
If > 55 or red flags present or treatment fails
- Upper GI endoscopy + biopsy (biopsy for gastric ulcers mainly to rule out malignancy)
- If ulcer is present: repeat endoscopy 6-8 weeks after treatment to confirm resolution and exclude malignancy
Blood- FBC-> LOOK FOR ANAEMIA
what is the acute management for peptic ulcer disease?
Fluid resuscitation needed if the ulcer is perforated or bleeding (IV colloids/crystalloids)
Close monitoring of vital signs
Endoscopy
Surgical treatment
NOTE: patients with upper GI bleeding should be treated with IV PPIs at presentation until the cause of bleeding is identified
If the ulcer is bleeding, how can haemstasis be acheived?
Injection sclerotherapy
Laser coagulation
Electrocoagulation
Surgery: Indicated if the ulcer has perforated or if the bleeding ulcer can’t be controlled
what is the management for H pylori eradication?
Triple therapy for 1-2 weeks
Various combinations may be recommended - usually a combination of 2 antibiotics + PPI (high dose) (e.g. clarithromycin 500mg + amoxicillin 1g/metronidazole 400mg + omeprazole) - taken twice daily
what is the management if the peptic ulcer disease is not associated with H pylori?
Treat with PPIs (e.g. lanzoprazole) or H2 antagonists (e.g. ranitidine)
Stop NSAID/bisphosphonates use
Use misoprostol (prostoglandin E1 analogue) if NSAID use is necessary
What should you do if the peptic ulcer is consistent for 6 months despite treatment?
surgery due to risk of complications- can inject adrenaline into ulcer and clip endoscopically
what are the possible complications of peptic ulcer disease?
Haemorrhage (haematemesis (coffee-ground), melaena, iron-deficiency anaemia)
- Endoscopy - adrenaline injection (1:10,000)
- May need IV PPI
- Maybe need a blood transfusion
Perforation – more commonly seen with duodenal (anterior and superficial parts)
- Sudden sever epigastric pain which rad to shoulder, V and shock signs
- Seen as air under diaphragm - pneumoperitoneum
- NBM and AB
- Endoscopy - first line treatment: adrenaline injection into bleeding site or clip application
- If fails then cover with omental plug (surgical repair)
- IV PPI may be needed later
Obstruction/pyloric stenosis (due to scarring, penetration, pancreatitis)
- Pyloric stenosis - more in children
- Cancers - more in elderly
- V (undigested food), abdo distention, weight loss, malaise lethargy , met alkalosis
- Resus, NG tube, endoscopy/surgical intervention
how is haemorrhage as a complication of peptic ulcer treated? and what are the symptoms?
(haematemesis (coffee-ground), melaena, iron-deficiency anaemia)
Endoscopy - adrenaline injection (1:10,000)
May need IV PPI
Maybe need a blood transfusion
what are the symptoms of a perforated peptic ulcer and how is it treated?
- Sudden sever epigastric pain which rad to shoulder, V and shock signs
- Seen as air under diaphragm - pneumoperitoneum
- NBM and AB
- Endoscopy - first line treatment: adrenaline injection into bleeding site or clip application-> if fails then cover with omental plug (surgical repair)
- IV PPI may be needed later
summarise the prognosis of peptic ulcer disease?
Overall lifetime risk = 10%
Outlook is generally good because peptic ulcers associated with H. pylori can be cured by eradication