Peptic ulcers

Question 1

What is the pathophysiology of peptic ulcers?

Answer 1

Disruption to the mucus barrier of the stomach, or an increase in stomach acid increases the risk of mucosal ulceration

Question 2

Where are ulcers most common?

Answer 2

In the proximal duodenum

Question 3

What are the risk factors for peptic ulcer disease?

Answer 3

Increasing age
H. pylori
NSAIDs
Other drugs
- SSRIs, corticosteroids and bisphosphonates
Smoking and alcohol
Raised ICP
Severe burns

Question 4

What is the presentation of peptic ulcer disease?

Answer 4

Duodenal ulcer
- Pain relieved by eating and worse when hungry
Gastric ulcer
- Pain worsened by eating
Nausea and vomiting
Coffee-ground vomiting or melaena
Reduced appetite and weight loss
Anaemia
Evidence of bleeding
- Hypotension and tachycardia
Epigastric tenderness

Question 5

What is the gold standard investigation for diagnosis of peptic ulcer disease?

Answer 5

Endoscopy

Question 6

What other investigations are helpful in the diagnosis of peptic ulcer disease?

Answer 6

H. pylori breath test
FBC
U&Es
LFTs and coagulation profile

Question 7

What is the glasgow blatchford score?

Answer 7

Score that assesses risk for upper GI bleed. Factors taken into account include:
- Haemoglobin
- Urea
- Initial systolic blood pressure
- Gender
- Tachycardia
- Melaena
- History of syncope
- Cardiac failure

Question 8

What is the management of peptic ulcers with no active bleeding?

Answer 8

Medication cessation
PPI for one month until ulcer has healed
Triple eradication therapy if H. pylori positive

Question 9

What is the management of peptic ulcer disease with active bleeding?

Answer 9

IV crystalloid
ABCDE and wide-bore IV access
Blood transfusion
Upper GI endoscopy - within 24 hours
High dose IV PPI

Question 10

What are the complications of peptic ulcer disease?

Answer 10

Bleeding from ulcer
Gastric outlet obstruction
Perforation - peritonitis