Peptic ulcers

Question 1

What are peptic ulcers and where do they occur?

Answer 1

Peptic ulcers are open sores that form in the mucosa of the stomach (gastric ulcer) or the proximal duodenum (duodenal ulcer). Duodenal ulcers are more common than gastric ulcers.

Question 2

What is the pathophysiology behind peptic ulcers?

Answer 2

The mucosa of the stomach and duodenum secretes mucus and bicarbonate to form a protective barrier against stomach acid and digestive enzymes. Disruption of this barrier, or factors that increase stomach acid, can lead to mucosal ulceration.

Question 3

What are the risk factors that contribute to peptic ulcers?

Answer 3

• Disruption of mucus barrier: Helicobacter pylori, Non-steroidal anti-inflammatory drugs (NSAIDs)
• Increase in stomach acid: Stress, Alcohol, Caffeine, Smoking, Spicy foods
• Increased bleeding risk: NSAIDs, Aspirin, Anticoagulants, Steroids, SSRIs

Question 4

What are the common symptoms of peptic ulcers?

Answer 4

• Epigastric discomfort or pain
• Nausea and vomiting
• Dyspepsia

Question 5

What are the signs of upper gastrointestinal bleeding due to peptic ulcers?

Answer 5

• Haematemesis (vomiting blood)
• Coffee ground vomiting
• Melaena (black, tarry stools)
• Fall in haemoglobin (on a full blood count)

Question 6

What complication can result from chronic microscopic bleeding from a peptic ulcer?

Answer 6

Chronic microscopic bleeding can lead to iron deficiency anaemia, characterized by low haemoglobin, low mean cell volume (MCV), and low ferritin levels.

Question 7

How can gastric and duodenal ulcers be differentiated based on pain and eating habits?

Answer 7

• Gastric ulcers: Pain worsens with eating, leading to weight loss due to fear of eating.
• Duodenal ulcers: Pain improves immediately after eating but returns 2-3 hours later, with stable or increased weight.

Question 8

How are peptic ulcers diagnosed?

Answer 8

Peptic ulcers are diagnosed through endoscopy, where a rapid urease test (CLO test) can be performed to check for H. pylori. A biopsy may also be taken to exclude malignancy.

Question 9

What is the management strategy for peptic ulcers?

Answer 9

• Stop NSAID use
• Treat H. pylori infections (with antibiotics)
• Use proton pump inhibitors (e.g., lansoprazole, omeprazole)
• Repeat endoscopy after 4-8 weeks to ensure healing.

Question 10

What are the complications of peptic ulcers?

Answer 10

• Bleeding: A common, potentially life-threatening complication.
• Perforation: Causes acute abdominal pain and peritonitis, requiring urgent surgical repair (usually laparoscopic).
• Gastric outlet obstruction: Scarring and strictures lead to difficulty emptying the stomach, causing fullness, discomfort, distention, and vomiting. It may be treated with balloon dilatation or surgery.