peptic ulcers

Question 1

what

Answer 1

ulceration of mucosa of the stomach (gastric ulcer) or the duodenum (duodenal ulcer)

duodenal ulcers aer more common

Question 2

stomach mucosa is prone to ulceration from

Answer 2

• breakdown of protective layer of stomach and duodenum

- increase in stomach acis

Question 3

what can the protective layer in stomach be broken down by

Answer 3

medications - steroids, NSAIDs

H. pylori

Question 4

what can cause increases in stomach acid

Answer 4

stress
alcohol 
caffeine 
smoking 
spicy foods

Question 5

clinical presentation

Answer 5

epigastric discomfort/pain, 
N&V,
dyspepsia,
bleeding - haematemesis, coffee ground vomit, meleana,
Fe deficient anaemia

Question 6

how does eating effect the pain assoc w peptic ulcers

Answer 6

worsens pain of gastric ulcers

improves pain of duodenal ulcers

Question 7

diagnosing peptic ulcers

Answer 7

Endoscopy

• rapid urease test can be done to check for h.pylori
• biopsy to exclude malignancy

Question 8

management of peptic ulcer

Answer 8

high dose PPI

endoscopy can be used to monitor healing and for assessment of further ulcers

Question 9

peptic ulcer complications

Answer 9

bleeding
perforation
scarring and stricutres

Question 10

what can scarring and strictures lead to

Answer 10

narrowing of pylorus, causing difficulty in emptying stomach contents
–> pyloric stenosis

Question 11

pyloric stenosis presentation

Answer 11

upper abdo pain
distention
N&V
esp after eating

Question 12

peptic ulcer perforation - presentation

Answer 12

epigastric pain, later becoming more generalised

syncope

Question 13

peptic ulcer perforation - Ix

Answer 13

erect CXR (if present with acute upper abdo pain)