Peptic Ulcers

Question 1

What are the 2 types of peptic ulcer?

Answer 1

Gastric ulcer

Duodenal ulcer

Question 2

Why do peptic ulcers form?

Answer 2

Breakdown of protective layer of mucus and bicarbonate due to steroid or NSAIDs or h.pylori

Increased stomach acid production
Eg stress/alcohol/caffeine/smoking/spicy foods

Question 3

How would someone suffering from peptic ulcer typically present?

Answer 3

Epigastric pain 
Nausea + vomiting 
Dyspepsia (indigestion/heartburn) 
Haematemesis i.e. coffee-ground vomit
Melaena 
Anaemia

Question 4

Which type of peptic ulcer does eating cause worse pain for?

Answer 4

Gastric ulcer

I.e. eating improves pain associated with duodenal ulcers

Question 5

What type of anaemia can be associated with peptic ulcers?

Answer 5

Depends on whether iron stores have been sufficiently depleted

Normocytic normochromic anaemia with blood loss where iron stores sufficient

Iron deficiency anaemia due to chronic blood loss
=causes microcytic anaemia

Question 6

How are peptic ulcers diagnosed?

Answer 6

OGD

Question 7

What are the possible complications of peptic ulcers?

Answer 7

Bleeding
Perforation= can lead to peritonitis
Scarring and strictures= narrows pylorus which leads to problem with emptying stomach contents i.e. PYLORIC STENOSIS

Question 8

How would someone with pyloric stenosis present?

Answer 8

Upper abdo pain
Abdo distention
Nausea and vomiting esp after eating

Question 9

What are the key features of gastric ulcers and duodenal ulcers?

Answer 9

DU

• more common and GU
• associated with increased gastric acid production and decreased gastric emptying i.e. acts to lower the pH in the duodenum
• 90% of cases associated with H pylori

GU

• more common in elderly and associated with the lesser curve of the stomach
• associated with reflux of duodenal contents and delayed gastric emptying

Question 10

What is Zollinger-Ellison syndrome and why is it associated with peptic ulcers? What symptoms is it associated with?

Answer 10

Peptic ulcers associated with a gastrin secreting tumour i.e. gastrinoma
-excessive gastrin release leads to excessive gastric acid production which produces multiple ulcers in duodenum and stomach

Gastrinoma usually arises in the pancreas (or sometimes the stomach or duodenum)

Abdo pain and dyspepsia
Chronic diarrhoea + steatorrhea due to inactivation of pancreatic enzymes