Peptic ulcers

Question 1

What does PUD stand for?

Answer 1

Peptic Ulcer Disease

Question 2

Where does PUD affect?

Answer 2

Punched out round holes in either stomach or duodenum

Question 3

Are gastric or duodenal ulcers more common?

Answer 3

Duodenal

Question 4

Where are gastric ulcers most commonly located within the stomach?

Answer 4

Lesser curve

Question 5

What are causes of gastric ulcers?

Answer 5

H pylori
NSAIDs
Zollinger Ellison syndrome

Question 6

What is Zollinger Ellison syndrome?

Answer 6

Rare digestive disorder, likely to have at least one tumour called a gastrinoma in small intestine or pancreas. Releases hormone gastrin which enhances gastric motility, mucosal growth and HCl production.

Question 7

What is the triad of Zollinger Ellison syndrome?

Answer 7

Pancreatic tumour
Gastric acid hypersecretion
Widespread peptic ulcers

Question 8

What are symptoms of gastric ulcers?

Answer 8

Epigastric pain
Worse on eating
Better between meals and with antacids
Typically involves weight loss

Question 9

What are red flags with peptic ulcer symptoms?

Answer 9

Aged over 55
Haematemesis
Melaena (tarry faeces, upper GI bleed)
Anaemia
Dysphagia

Question 10

How are gastric ulcers diagnosed?

Answer 10

Check no red flags
C-urea breath test (h. pylori)
Stool antigen test (h. pylori)

Question 11

If there are red flags when suspecting gastric ulcers, what should be done?

Answer 11

Urgent endoscopy and biopsy

Question 12

How are gastric ulcers treated?

Answer 12

Stop NSAIDs

If pylori positive then give triple therapy CAP = clarithromycin, amoxicillin and PPI

Question 13

If peptic ulcer disease is found, when do you rescope?

Answer 13

6-8 weeks later

Question 14

If the patient has a penicillin allergy, what is the treatment for h. pylori causing peptic ulcers?

Answer 14

Clarithromycin, metronidazole (instead of amoxicillin), PPI

Question 15

What is a complication of gastric ulcers?

Answer 15

Bleeding due to ruptured left gastric artery (uncommon)

Question 16

Where exactly are duodenal ulcers most commonly located?

Answer 16

D1 or D2 posterior wall

Question 17

What are causes of duodenal ulcers?

Answer 17

H. pylori (most common)

More common in gastric ulcers:
NSAIDs
Zollinger Ellison syndrome

Question 18

True or false: duodenal ulcers cause epigastric pain that is worse between meals and better with food

Answer 18

True
(food buffers acid a bit)

Question 19

True or false: typically there is weight loss with duodenal ulcers

Answer 19

False
typically weight gain (eat more to relieve pain)

Question 20

How are duodenal ulcers diagnosed?

Answer 20

If no red flags:
Urea breath test (h pylori)
Stool antigen test (h pylori)

Question 21

What happens next if there are red flags when suspecting duodenal ulcers?

Answer 21

Urgent endoscopy and biopsy

Question 22

What will the biopsy show if there is a duodenal cancer?

Answer 22

Brunner’s gland hyperplasia (causing more mucous production)

Question 23

What must happen if you are testing for H pylori in either gastric or duodenal ulcers?

Answer 23

Patient must be taken off PPI for at least 2 weeks otherwise may be false negative result

Question 24

What is treatment for duodenal ulcers?

Answer 24

Stop NSAIDs
If H. pylori positive give triple therapy: CAP

Clarithromycin, amoxicillin and PPI

(If allergic to penicillin then metronidazole is given instead of amoxicillin)

Question 25

What is a complication of duodenal ulcers?

Answer 25

Bleeding due to ruptured gastroduodenal artery (very common)