Peptic Ulcer Dx Flashcards
Which is more common in men ,duodenal or gastric ulcers?
Duodenal
Which is more common in women ,duodenal or gastric ulcers?
Gastric
Is mortality rate high for Peptic ulcer
No
Main location of peptic ulcers
Oesophagus
Stomach
Duodenum
Disease associated with peptic ulcer
Zollinger-Ellison syndrome
Meckel’s diverticulum With ectopic gastric mucosa
What is peptic ulcer disease
Breaks in the gastric and duodenal mucosa Due to the corrosive action of pepsin and hydrochloric acid
Symptoms of peptic ulcer disease
Abdominal discomfort
pain (Epigastric, does not radiate, Burning or gnawing, Temporary relief with antacids)
nausea
Which type of ulcer has worsening of pain When eating With patient presenting with weightloss
Gastric ulcer
Which type of ulcer has relief of pain When eating
Duodenal ulcers
Two main causes of peptic ulcer disease
Decreased Protective ability of mucosa
Acid hypersecretion
Hostile factors leading to peptic ulcer
Gastric acid
H pylori
NSAIDs
Pepsin
Protective factors that reduce chances of peptic ulcers
Prostaglandins
Mucus
Bicarbonate
Blood flow
Enzyme affected by NSAIDs
COX 2
Triad of zollinger Ellison syndrome
Peptic ulcer in unusual location (jéjunum )
massive gastric acid hypersecretion
Gastric producing islet cells tumor of pancreas (gastrinoma )
Risk factors of peptic ulcers
H pylori
NSAIDs
Zollinger Ellison syndrome
Hypercalcemia
Genetic factors
Smoking
Stress
Alcohol
Diet
Investigations
Barium X ray
Upper GI series
Endoscopy
Lab test in patient with recurrent peptic ulcer
Serum gastrin ,Serum calcium - gastrinoma
Histology biopsy of gastric antrum during endoscopy - h . Pylori
Urea Breath tests - h. Pylori
Serologic Elisa for h. Pylori
Stool antigen testing for h pylori
Most accurate method to diagnose h pylori
Endoscopic biopsy
Treatment
Antacids - H2 antagonists , PPI
Mucosal protection - prostaglandins, sulcrafate
Antibiotics - h pylori
Complications of ulcers
Perforation
Penetration
Hemorrhage
GOO
Most common complication of ulcer
Hemorrhage
Percentage of ulcer hemorrhage that resolve alone
75-80%
Percentage of perforation
5-10%
Two forms of perforation
Free perforation leading to acute abdomen
Contained perforation
Symptoms of perforation
Severe abdominal pain
Epigastrium pain worse
Nausea
Vomiting
Acute illness
Most common site of penetration
Pancreas
Type of ulcer that lead to GOO
Duodenal ulcers
GOO symptoms
Nausea
vomiting
Epigastric pain
Epigastric Fullness
