peptic ulcers Flashcards
what is a peptic ulcer ?
chronic mucosal defect where there is an attack of pepsin
what are the types of peptic ulcer diseases ?
duodenal ulcers
gastric ulcers
oesophageal ulcers
what is the pathogenesis of peptic ulcer diseases?
hyperacidity
decreased mucosal defense mechanism
what is the main pathogenesis in gastric ulcers ?
decreased mucosal defense
what is the main pathogenesis with peptic ulcers of the duodenum ?
hyperacidity
what are the main causes of PUD?
NSAIDS h.pylori smoking genetics stress
what are the types of gastric ulcers ?
benign malignant
what are the causes of gastric ulcers ?
h.pylori infection delayed gastric emptying defective mucosal barrier bile reflux into the stomach NSAIDS
what are the symptoms of gastric ulcers ?
pain provoked by food intake
localized pain in the epigastric region
nausea and vomiting
how do we make a diagnosis of gastric ulcers ?
endoscopy
biopsy
what are the symptoms of duodenal ulcers ?
pain that is relieved by food intake
upper abdominal pain that radiates to the back
usually described as a burning pain
what are the causes of duodenal ulcers ?
hyper secretion of gastric acid increased number of parietal cells increased sensitivity of parietal calls to gastrin n reduced gastrin inhibition infection with h.pylori
what is the treatment approach to h.pylori infection ?
treatment regimens include
first line options
alternative or salvage options
levo-floxacillin containing drugs
what is the first line options for treatment of h.pylori ?
amoxicillin
PPI (omeprazole)
clarithomycin
what are the complications of peptic ulcer disease ?
haemorrhage
perforation
obstruction
what would a PU complicated with a haemorrhage look like ?
- if the penetration reaches a small vein - the patient will detect vomiting blood (haematemesis) or tarry black stool
- if the penetration reaches ann artery the bleeding will be alot
perforation is a more common complication in what type of ulcer ?
duodenal ulcer
what is the medical treatment required for PUD?
PPI’s
histamine receptor agonists
antacids
what are parietal cells responsible for ?
HCL secretion
what is the treatment for a bleeding ulcer disease ?
first step would be to resuscitate the patient
second step would be endoscopic treatment using one of the following methods :
- injection with saline
- heater probe
- clipping
what is the effect of the saline injection on the ulcer ?
induces vasoconstriction and induces a tamponade effect
what is Zollinger -Ellison syndrome ?
when a tumor is present and causes the stomach to produce ann excessive amount of acid resulting in a peptic ulcer
what is acute gastritis ?
acute inflammation of the gastric mucosa characterised by neutrophil infiltrate
what is the clinical presentation of acute gastritis ?
dyspepsia heartburn nausea vomiting epigastric pain
what are the causes of gastritis ?
infectious and non-infectious
what are the non-infectious causes of gastritis ?
autoimmune
Alcohol
allergy to gluten
crohn’s disease
which type of gastritis is pre malignant ?
atrophic gastritis
what are the two types atrophic gastritis ?
autoimmune:
mucosal atrophy in the fundus and corpus region
h.pylori-related gastritis:
inflammation mainly occurs mainly in the Antrum
what are the causes of haemorrhagic gastritis ?
often drug induced
what is haemorrhagic gastritis usually indistinguishable from ?
telengectasia
how is haemorrhagic gastritis differentiated from gastric purpura ?
thrombocytopenia
in what age group is chemo toxic gastritis usually found in ?
children
what are the causes of rugal hyperplastic gastritis or giant fold gastritis ?
Zollinger-Ellison syndrome
lymphoma
carcinoma
post-operative stomach
what are the complications of chronic gastritis ?
increased risk of tumors:
adenocarcinoma
carcinoid
MALT lymphoma
