Peptic ulcers Flashcards
Aetiology of peptic ulcers
Peptic ulcers involve ulceration of the mucosa of the stomach (gastric ulcer) or the duodenum (duodenal ulcer). Duodenal ulcers are more common.
Pathophysiology of peptic ulcers
The stomach mucosa is prone to ulceration from:
- breakdown of the protective layer (mucus and bicarbonate secreted by the stomach mucosa) of the stomach and duodenum.
- increase in stomach acid
The protective layer (mucus and bicarbonate) can be broken down by:
- medications (e.g. steroids or NSAIDs)
- H.pylori
Risk factors
- NSAIDS
- steroids
- stress
- alcohol
- caffeine
- smoking
- spicy foods
Clinical presentation of peptic ulcers
- epigastric discomfort or pain
- nausea and vomiting
- dyspepsia
- bleeding causing haematemesis, “coffee ground” vomiting and malena
- iron deficiency anaemia (due to constant bleeding)
TOM TIP: In your MCQ exams, eating typically worsens the pain of gastric ulcers and improves the pain of duodenal ulcers.
Investigation/Diagnosis
- diagnosed by endoscopy
- during endosopy → a rapid urease test (CLO test) can be performed to check for H.pylori.
- biopsy should be considered during endoscopy to exclude malignancy as cancers can look similar to ulcers during the procedure
Treatment of peptic ulcers
Medical treatment: same as with GORD, usually with high dose PPI
- endoscopy can be used for monitoring the ulcer to ensure it heals and to assess for futher ulcers
Complications of peptic ulcers
BLEEDING → common and potentially life threatening
PERFORATION → resulting in an “acute abdomen” and peritonitis. requires urgent surgical repair (usually laparoscopic)
SCARRING & STRICTURES → of the muscle and mucosa → narrowing of the pylorus (exit of the stomach) causing difficulty in emptying the stomach contents. known as pyloric stenosis. this presents with upper abdominal pain, distention, nausea and vomiting, particularly after eating.
