Peptic Ulcers Flashcards
what is the definition of peptic ulcers?
A break in the mucosal lining of the stomach or duodenum more than 5 mm in diameter, with depth to the submucosa. Ulcers smaller than this or without obvious depth are called erosions.
what is the epidemiology of peptic ulcers?
The incidence of peptic ulcer increases with age; gastric ulcers peak in the fifth to seventh decades and duodenal ulcers 10 to 20 years earlier
what is the aetiology of peptic ulcers?
The two major aetiologic factors responsible for peptic ulceration are infection by the gram-negative gastric pathogen Helicobacter pylori and the use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). There is some synergy between these two major causes
what are the risk factors of peptic ulcers?
Helicobacter pylori infection NSAIDs Smoking Age Personal and family history Intensive care
what is the pathophysiology of peptic ulcers?
Peptic ulcers result from an imbalance between factors that can damage the gastroduodenal mucosal lining and defence mechanisms that normally limit the injury. Aggressive factors include gastric juice (including hydrochloric acid, pepsin, and bile salts refluxed from the duodenum), Helicobacter pylori, and non-steroidal anti-inflammatory drugs (NSAIDs). Mucosal defences comprise a mucus bicarbonate layer secreted by surface mucus cells forming a viscous gel over the gastric mucosa. Also key is the integrity of tight junctions between adjacent epithelial cells, and the process of restitution, whereby any break in the epithelial lining is rapidly filled by adjacent epithelial and mucosal stromal cells that migrate to fill the gap. Mucosal defences rely heavily on an adequate blood supply.
what are the key presentations of peptic ulcers?
Abdominal pain
Presence of risk factors
Pointing sign
what are the signs of peptic ulcers?
Risk factors Pointing sign Anaemia Hypotension Succussion splash
what are the symptoms of peptic ulcers?
Abdo pain Nausea Vomiting Early satiety Diarrhoea Weight loss GI bleeding
what are first line and gold standard investigations for peptic ulcers?
Upper GI endoscopy - peptic ulcer, and cause
Helicobacter pylori carbon-13 urea breath test or stool antigen test - pos if H pylori is cause
FBC - microcytic anaemia or high platelet count
what is the differential diagnoses of peptic ulcers?
Oesophageal cancer
Stomach cancer
GORD
how is peptic ulcers managed?
Acute:
Bleeding - blood transfusion?, endoscopy, PPI
Not bleeding - PPI, underlying cause treatment, H2 antagonist
how is peptic ulcers monitored?
People with gastric ulcer and H pylori should be followed up with a repeat endoscopy 6 to 8 weeks after beginning treatment, depending on the size of the lesion.
what are the complications of peptic ulcers?
Penetration
Gastric outlet obstruction
GI bleeding
Perforation
what is the prognosis fo peptic ulcers?
With proton-pump inhibitor (PPI) therapy, duodenal ulcers typically heal within 4 weeks and gastric ulcers within 8 weeks
