Peptic Ulceration Flashcards
What is the peptic ulceration?
It is is defined as a condition in which there is ulceration of the gastrointestinal mucosa
In which two areas of the gastrointestinal tract does peptic ulceration tend to develop?
Stomach
Duodenum
What is more common - gastric ulcers or duodenal ulcers?
Duodenal ulceration
What are the two general causes of peptic ulceration?
Increased secretion of gastric acid
OR
The breakdown of gastrointestinal mucosa
What are the six risk factors of peptic ulceration?
Helicobacter Pylori Infection
NSAID Administration
Steroid Administration
Smoking
Alcoholism
Stress
What is the most common risk factor of peptic ulceration?
Helicobacter Pylori Infection
What are the five clinical features of peptic ulceration?
Epigastric Pain
Nausea & Vomiting
Haematemesis
Abdominal Bloating
Heartburn
Do gastric ulcer features improve upon eating or worsen?
Worsen
Do duodenal ulcer features improve upon eating or worsen?
Improve
Which two investigations are used to diagnose peptic ulceration?
Helicobacter Pylori Testing
Endoscopy + Biopsy
What two tests are used to identify H.Pylori infection?
Urea Breath Test
Stool Antigen Test
What is the urea breath test?
It involves consumption of a urea containing liquid, which is a chemical broken down by H.Pylori into ammonia and carbon dioxide
After fifteen minutes, the volume of carbon dioxide exhaled is measured
What is a positive urea breath test?
Increased volumes of exhaled carbon dioxide
Which two drug classes can reduce the accuracy of the urea breath test?
Antibiotics within 4 weeks
Antisecretory drugs, such as PPIs, within 2 weeks
What is a stool antigen test?
It involves testing a stool sample for the presence of H.Pylori infection
What is the gold standard investigation used to diagnose peptic ulceration?
Endoscopy + Biopsy
How is endoscopy, with biopsy, used to investigate peptic ulceration?
The endoscopy is used to visualise peptic ulceration
The biopsies are conducted to exclude malignancy
What are the five conservative management options of peptic ulceration?
NSAID Cessation
Steroid Cessation
Smoking Cessation
Alcohol Cessation
Stress Reduction
What are the four pharmacological management options of peptic ulceration?
Antacid Drugs
Proton Pump Inhibitors (PPIs)
H2 Receptor Antagonist
Antibiotics
Name two antacid drugs used to manage peptic ulceration
Gaviscon
Rennie
When are antacid drugs used to manage peptic ulceration?
They are over the counter medications that patients can be advised to purchase
What is the mechanism of action of antacids?
They neutralise stomach acid and inhibit pepsin
How do antacid drugs treat peptic ulceration?
They can be administered to provide temporary symptomatic relief, however, don’t provide resolution of the underlying damage
Name two proton pump inhibitors (PPIs) used to manage peptic ulceration
Omeprazole
Lansoprazole
When are proton pump inhibitors used to manage peptic ulceration?
They are the first line management option
How do proton pump inhibitors (PPIs) manage peptic ulceration?
They inhibit gastric acid secretion by binding to the hydrogen potassium ATPase pump that resides on the luminal surface of the parietal cell membrane
This provides time for the damaged tissue to heal
What are the two side effect of PPIs?
Hyponatraemia
C.Difficile Infection
Name a H2 receptor antagonist used to manage peptic ulceration
Ranitidine
When are H2 receptor antagonists used to manage peptic ulceration?
They are the second line management option
How do H2 receptor antagonists treat peptic ulceration?
They inhibit gastric acid secretion and by binding to histamine type 2 receptors on the basolateral surface of gastric parietal cells
This provides time for the damaged tissue to heal
Name three antibiotics are used to manage peptic ulceration
Amoxicillin
Clarithromycin
Metronidazole
When are antibiotics used to manage peptic ulceration?
When peptic ulceration is related to H.Pylori infection
They are administered in combination with proton pump inhibitors
What investigation is used to test effectiveness of H.plorie eradication therapy?
Urea Breath Test
What are the three complications of peptic ulceration?
Gastrointestinal Bleeding
Gastrointestinal Perforation
Gastric Obstruction
What investigation is used to diagnose peptic ulcer perforation?
Erect CXR
What is a feature of peptic ulceration perforation on CXR?
Free air under the diaphragm
