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4th year passmedicine by topic > Peptic Ulcers > Flashcards

Peptic Ulcers Flashcards

1
Q

Helicobacter pylori is a

A

Gram-negative bacteria

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2
Q

Helicobacter pylori Associations

A

peptic ulcer disease
gastric cancer
B cell lymphoma of MALT tissue
atrophic gastritis

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3
Q

H pylori seen in ?% of duodenal ulcers, ?% of gastric ulcers

A

95% of duodenal ulcers, 75% of gastric ulcers

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4
Q

B cell lymphoma of MALT tissue - eradication of H pylori results causes regression in ?% of patients

A

eradication of H pylori results causes regression in 80% of patients

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5
Q

Helicobacter pylori mx

A

eradication may be achieved with a 7 day course of

a proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole)

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6
Q

Helicobacter pylori mx if penicillin allergic:

A

a proton pump inhibitor + metronidazole + clarithromycin

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7
Q

Peptic ulcer disease (uncomplicated) drug associations?

A

NSAIDs
SSRIs
corticosteroids
bisphosphonates

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8
Q

Peptic ulcer disease (uncomplicated) sx

A

epigastric pain
nausea

duodenal ulcers - epigastric pain when hungry, relieved by eating
gastric ulcers - epigastric pain worsened by eating

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9
Q

Peptic ulcer disease (uncomplicated) ix

A

Helicobacter pylori should be tested for

either a Urea breath test or stool antigen test should be used first-line

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10
Q

Peptic ulcer disease (uncomplicated) mx

A

if Helicobacter pylori is negative then proton pump inhibitors (PPIs) should be given until the ulcer is healed

if Helicobacter pylori is positive then eradication therapy should be given

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11
Q

The symptoms of perforation secondary to peptic ulcer disease typically develop slowly

A

false

suddenly

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12
Q

The symptoms of perforation secondary to peptic ulcer disease include?

A

epigastric pain, later becoming more generalised

patients may describe syncope

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13
Q

Peptic ulcer disease (perforation) plain x rays diagnostic

A

false

diagnosis is largely clinical, UptoDate recommend that plain x-rays are the first form of imaging to obtain

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14
Q

Peptic ulcer disease (perforation) An upright (‘erect’) chest x-ray shows

A

75% of patients with a perforated peptic ulcer will have free air under the diaphragm

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15
Q

Bleeding is the most common cause of peptic ulcer disease, account for around three-quarters of problems.

A

true

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16
Q

Which artery can be the source of a significant gastrointestinal bleed occurring as a complication of peptic ulcer disease.

A

The gastroduodenal artery can be the source of a significant gastrointestinal bleed occurring as a complication of peptic ulcer disease.

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17
Q

Peptic ulcer disease (acute bleeding) sx

A

haematemesis
melaena
hypotension, tachycardia

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18
Q

Peptic ulcer disease (acute bleeding) mx

A

ABC
IV proton pump inhibitor
first-line treatment is endoscopic intervention
if this fails - urgent interventional angiography with transarterial embolization or
surgery

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19
Q

Helicobacter pylori: tests
should not be performed within ? weeks of treatment with an antibacterial or within ? weeks of an antisecretory drug (e.g. a proton pump inhibitor)

A

should not be performed within 4 weeks of treatment with an antibacterial or within 2 weeks of an antisecretory drug (e.g. a proton pump inhibitor)

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20
Q

Helicobacter pylori: tests

urea breath test may be used to check for H. pylori eradication

A

true

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21
Q

Helicobacter pylori: tests

Rapid urease test (e.g. CLO test) describe

A

biopsy sample is mixed with urea and pH indicator

colour change if H pylori urease activity

22
Q

Helicobacter pylori: tests
Serum antibody
remains positive after eradication

A

true

23
Q

Helicobacter pylori: tests Gastric biopsy describe

A

provides histological evaluation alone, no culture

culture of this provide information on antibiotic sensitivity

24
Q

Gastric cancer - Epidemiology

A

peak age = 70-80 years
more common in east than the West
more common in males, 2:1

25
Q

Gastric cancer - Histology

A

signet ring cells

large vacuole of mucin which displaces the nucleus to one side.

26
Q

Gastric cancer Higher numbers of signet ring cells are associated with a worse prognosis

A

true

27
Q

Gastric cancer Associations

A 
H. pylori infection
blood group A: gAstric cAncer
gastric adenomatous polyps
pernicious anaemia
smoking
diet: salty, spicy, nitrates
may be negatively associated with duodenal ulcer
28
Q

Gastric cancer sx

A

dyspepsia
nausea and vomiting
anorexia and weight loss
dysphagia

29
Q

Gastric cancer ix

A

diagnosis: endoscopy with biopsy
staging: endoscopic ultrasound has recently been shown to be superior to CT

30
Q

Tumours of the gastro-oesophageal junction are classified as

A

Type 1 - True oesophageal cancers and may be associated with Barrett’s oesophagus.
Type 2 Carcinoma of the cardia, arising from cardiac type epithelium
or short segments with intestinal metaplasia at the oesophagogastric junction.
Type 3 Sub cardial cancers that spread across the junction. Involve similar nodal stations to gastric cancer.

31
Q

Gastric cancer staging ix

A 
CT scanning of the chest abdomen and pelvis is the routine first line staging investigation in most centres.
Laparoscopy to identify occult peritoneal disease
PET CT (particularly for junctional tumours)
32
Q

Gastric cancer Treatment Most patients will receive chemotherapy either pre or post operatively.

A

true

33
Q

Gastric cancer mx

A

Proximally sited disease greater than 5-10cm from the OG junction may be treated by sub total gastrectomy
Total gastrectomy if tumour is <5cm from OG junction

34
Q

Gastric cancer mx

type 2 junctional tumours

A

oesophagogastrectomy is usual

35
Q

Gastric cancer prognosis - Percentage 5 year survival

A 
All RO resections	54%
Early gastric cancer	91%
Stage 1	87%
Stage 2	65%
Stage 3	18%
36
Q

Zollinger-Ellison syndrome is

A

ondition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas

37
Q

Zollinger-Ellison syndrome is associated with MEN IIB

A

false

Around 30% occur as part of MEN type I syndrome

38
Q

Zollinger-Ellison syndrome features

A

multiple gastroduodenal ulcers
diarrhoea
malabsorption

39
Q

Zollinger-Ellison syndrome diagnosis

A

fasting gastrin levels: the single best screen test

secretin stimulation test

40
Q

Acute upper gastrointestinal bleeding

which scores to use and when?

A

use the Blatchford score at first assessment, and

the full Rockall score after endoscopy

41
Q

Blatchford score looks at

A 
Urea (mmol/l)
Haemoglobin (g/l)
Systolic blood pressure (mmHg)
Pulse >=100/min = 1
Presentation with melaena = 1
Presentation with syncope = 2
Hepatic disease = 2
Cardiac failure = 2
42
Q

Patients with a Blatchford score of 0 may be considered for early discharge.

A

true

43
Q

Acute upper gastrointestinal bleeding if actively bleeding transfuse with?

A

platelet transfusion

44
Q

Acute upper gastrointestinal bleeding if actively bleeding when to transfuse with FFP

A

fibrinogen level of less than 1 g/litre, or a prothrombin time (international normalised ratio) or activated partial thromboplastin time greater than 1.5 times normal

45
Q

Acute upper gastrointestinal bleeding if actively bleeding when to transfuse with prothrombin complex concentrate?

A

patients who are taking warfarin and actively bleeding

46
Q

Endoscopy

should be offered immediately after resuscitation in patients with a severe bleed

A

true

Within 24 hrs

47
Q

Acute upper gastrointestinal bleeding

Management of non-variceal bleeding PPIs before endoscopy

A

false
NICE do not recommend the use of proton pump inhibitors (PPIs) before endoscopy to patients with suspected non-variceal

PPIs should be given to patients with non-variceal upper gastrointestinal bleeding and stigmata of recent haemorrhage shown at endoscopy

48
Q

Acute upper gastrointestinal bleeding

Management of non-variceal bleeding

A

PPIs should be given to patients with non-variceal upper gastrointestinal bleeding and stigmata of recent haemorrhage shown at endoscopy

if further bleeding - repeat endoscopy, interventional radiology and surgery

49
Q

Acute upper gastrointestinal bleeding Management of variceal bleeding at presentation

A

terlipressin and prophylactic antibiotics should be given to patients at presentation (i.e. before endoscopy)

50
Q

Acute upper gastrointestinal bleeding Management of variceal bleeding
for patients with gastric varices

A

injections of N-butyl-2-cyanoacrylate for patients with gastric varices

transjugular intrahepatic portosystemic shunts (TIPS) should be offered if bleeding from varices is not controlled with the above measures

51
Q

Acute upper gastrointestinal bleeding Management of variceal bleeding
for oesophageal varices

A

band ligation should be used for oesophageal varices

transjugular intrahepatic portosystemic shunts (TIPS) should be offered if bleeding from varices is not controlled with the above measures

4th year passmedicine by topic (96 decks)

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