Peptic ulceration

Question 1

What is peptic ulceration?

Answer 1

Lesion occuring in mucous membrane

Question 2

What are the primary sites of peptic ulceration?

Answer 2

Stomach and duodenum

Question 3

Pathological cause of peptic ulcer?

Answer 3

Imbalance between acid secretion and mucosal barrier

Question 4

Main 3 causes of peptic ulceration

How do they cause the ulcer?

Answer 4

H.pylori; NSAIDs; smoking

Reduce ability of mucosal lining to resist acidic effects of gastric juice

Question 5

4 complications of ulceration

Answer 5

Bleeding
Perforation
Healing by fibrosis
Gastric outlet obstruction

Question 6

What does perforation lead to?

Answer 6

Peritonitis

Question 7

Difference between chronic & acute bleeding?

Answer 7

Chronic - anaemia

Acute - haemorrhage

Question 8

What does healing by fibrosis lead to?

Answer 8

Obstruction (fibrotic stricture)

Question 9

Gender prevalence of peptic ulceration?

Answer 9

Men>Women

Question 10

6 Symptoms of ulcer

Answer 10

Epigastric pain/epigastric tenderness
Nocturnal/hunger pain
Back pain
Nausea and occasional vomit
Weightloss
Haematemesis/melaenia

Question 11

Sign of ulcer

Answer 11

Anaemia

Question 12

What causes anaemia, haematemesis or melaenia in ulceration?

Answer 12

If the ulcer bleeds

Question 13

Investigations for ulceration?

Answer 13

Lab tests for H.pylori
Endoscopy
Barium swallow

Question 14

Treatment for ulcer caused by H.pylori?

Answer 14

Eradication therapy

Question 15

Treatment for ulceration with NSAID involvement?

Answer 15

stop NSAIDs or if not possible give extra protective agents

Question 16

When is surgery indicated for ulcer?

Answer 16

Only in complicated peptic ulcer disease

Question 17

General treatment measures for peptic ulcer?

Answer 17

Antacid medication - PPI or H2 receptor antagonist

Complications treated as they arise

Question 18

Describe the eradication therapy for H.pylori

Answer 18

Triple therapy for 7 days:
- Clarithromycin 500mg bd.
- Amoxycillin 1g bd (or Metronidazole 400mg bd)
(Tetracycline is given if penicillin allergy)
- PPI (omeprazole 20mg bd)