Peptic Ulcer Incl Perforation And Bleed

Question 1

Px

Answer 1

Nausea and vom
Epigastric pain
Duodenal relieved by food, cyclical, early morn
Gastric worse by food, wl, anorexia, less cyclical
Upper abdo distension
Fever
Guarding, tenderness
Tachy, hypot
Cardiac arrest

Question 2

Ix

Answer 2

Gastroscopy
Barium meal
Urease testing on antral biop or as CO2 breath test
Fasting serum gastrin (ZE panc gastrinoma)
If perforation-
FBC, LFT, UE, amylase, gluc, clott, GS
Fluids
Analgesia
Catheter
NBM
CXR
ECG
Sepsis 6
CT abdo pelvis

Question 3

Complics

Answer 3

Bleed
Iron defic anaemia
Perforation
Gastric outlet obstruc due to pyloric scarring

Question 4

Mx

Answer 4

Stop alc, smoking, NSAIDs
Medical if small perforat, stable. CT contrast to check if closed self.
PPI or H2 blocker
Topical antacids eg gaviscon, sucralfate, colloidal bismuth. Esp for acute ulceration post op.
Hp eradication- metronidazole, PPI, clarithromycin.
Resus
NG tube
Analgesia
IV PPI
Perforat Surg- wash and close eg omentum patch. Open or laparo.
Pyloroplasty or gastrectomy
Vascular repair if req

Question 5

diffs

Answer 5

Duod or gastric
Gastric carcinoma
Trauma
Usch eg volvulus- twist paraoes hernia