Peptic ulcers

Question 1

What are peptic ulcers

Answer 1

Ulceration of the mucosa of the stomach (gastric ulcers) or the duodenum (duodenal ulcers - more common)

Question 2

Causes of ulcers

Answer 2

Breakdown of protective layer of stomach mucosa e.g.
Medication - Steroids, NSAID’s
H. Pylori

Increased acid e.g.
Stress
Alcohol 
Caffeine 
Smoking
Spicy foods

Question 3

Cause of peptic ulcers

Answer 3

Break down of protective layer of stomach mucosa e.g.
Medications (Steroids, NSAID’s)
H. Pylori

Increased acid e.g. 
Stress
Alcohol
Caffeine
Smoking
Spicy foods

Question 4

Peptic ulcers presentation

Answer 4

Epigastric discomfort or pain
Nausea and vomiting
Dyspepsia
Haematemesis, coffee ground vomiting or melaena
Iron deficiency anaemia due to bleeding
Eating typically worsens pain of gastric ulcers and improves pain of duodenal ulcers

Question 5

Peptic ulcers management

Answer 5

Diagnosed by endoscopy
During endoscopy a rapid urease test (CLO test) can be performed to check for H. pylori
Biopsy to exclude malignancy as cancers can look similar
High dose PPI’s

Question 6

Peptic ulcers complications

Answer 6

Bleeding from ulcers
Perforation resulting in ‘acute abdomen’ and peritonitis - requires urgent laparoscopic surgical repair
Scarring and strictures of the muscle and mucosa - can cause narrowing of the pylorus (pyloric stenosis - upper abdo pain, distention, nausea and vomiting, particularly after eating)