Peptic ulcer disesae

Question 1

What is PUD?

Answer 1

Ulcers occurring in the stomach and duodenum as a result of increased offence (gastric acid secretion, H. pylori, bile salts) and decreased defence (mucin secretion, bicarbonate secretion, mucosal blood flow, cell turnover).

Question 2

What are symptoms of PUD?

Answer 2

Dyspepsia
Heartburn
Tender epigastrium

Question 3

Risk factors for PUD?

Answer 3

• H pylori infection
  
  • Drugs (NSAIDs, steroids, SSRI)
  • Smoking
  • Delayed gastric emptying/increased acid secretion
  • Zollinger-Ellison syndrome: gastrin secreting tumour

Question 4

Differential diagnoses for PUD?

Answer 4

GORD
Zollinger-Ellison syndrome
Gastritis
Duodenitis
Pancreatic cancer

Question 5

What investigations for PUD?

Answer 5

H, pylori tests: breath test and stool antigen.

Endoscopy.

Question 6

What is management of PUD?

Answer 6

Lifestyle
H pylori eradication

Drugs: PPI + H2RA

Stop any offending drugs e.g. aspirin, NSAIDs,

Question 7

What surgery can be done for PUD?q

Answer 7

Vagotomy: slow gastric secretion

Gastrectomy

Question 8

Complications of PUD?

Answer 8

Bleeding
Perforation
Malignancy
Decreased gastric outflow