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RM - GI Conditions Profile > Peptic Ulcers > Flashcards

Peptic Ulcers Flashcards

1
Q

Define peptic ulcers

A

A breach in the gastrointestinal mucosa as a result of acid or pepsin attack

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2
Q

What exacerbates the mucosal damage in a peptic ulcer formation?

A

The hyper-acidic environment of the stomach

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3
Q

What percentage of the population are affected by duodenal ulcers?

A

10%

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4
Q

What type of peptic ulcer is more common?

A

Duodenal (2-3x)

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5
Q

What age of people are peptic ulcers more common in?

A

Elderly

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6
Q

Peptic ulcers are more common in _____ countries

A

Developed

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7
Q

Peptic ulcers are linked with (deprivation/weath)

A

Deprivation

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8
Q

What causes 90% of DUs and 60% of GUs?

A

H. pylori

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9
Q

What are the 2 most prevalent causes of peptic ulcers?

A

H. pylori

NSAIDS

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10
Q

What condition/symptom is commonly caused by peptic ulcers?

A

Dyspepsia

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11
Q

What are the 4 (relatively) minor risk factors for peptic ulcers?

A

Increased stomach acid/duodenal acid load
Smoking
Blood group O
Stress

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12
Q

What rare condition is associated with the formation of peptic ulcers, and why?

A

Zollinger-Ellison syndrome

Tumour that secretes gastrin (=> increased acid)

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13
Q

Is a family history of peptic ulcers associated with their formation?

A

Yes

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14
Q

What risk factors often combine to form a peptic ulcer?

A

Too much acid and damage to mucosa

Increased attack and failure of defence

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15
Q

What thyroid condition are peptic ulcers associated with?

A

Hyperparathyroidism

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16
Q

What kind of pain is a classic feature of peptic ulcer presentation?

A

Recurrent, burning epigastric pain (can radiate to the back)

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17
Q

What kind of pain is very indicative of a peptic ulcer?

A

Pain that can be pointed to with one finger

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18
Q

When are the 2 times that DUs are classically painful?

A 
Before eating (relived by eating)
At night (as well as the day)
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19
Q

What percentage of DUs are asymptomatic?

A

50%

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20
Q

What is able to relive the pain of both types of peptic ulcers?

A

Antacids

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21
Q

What symptom is often associated with peptic ulcer pain?

A

Nausea

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22
Q

What 2 systemic symptoms are gastric ulcers often associated with?

A

Weight loss

Anaemia

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23
Q

What does persistent and severe pain in peptic ulcers indicate?

A

Complications such as penetration into other organs

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24
Q

What clinical feature can sometimes be induced/seen in peptic ulcer patients?

A

Epigastric tenderness

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25
What information is needed to help formulate a treatment plan for peptic ulcer patients?
H. pylori infection status
26
What are the 3 non-invasive tests for H. pylori?
Serological testing Urease breath test Faecal antigen test
27
What 2 immunoglobulins are looked for in an H. pylori serology test?
IgA, IgG
28
What are the 2 disadvantages of the serology test for H. pylori?
Not accurate in older patients | Does not show changes in infection status quickly (1 year) => no use in confirming presence or irradication
29
Describe a Urease Breath Test for H. pylori
Ingest urea, then test the CO2 concentration in the breath
30
What 2 medications must be stopped for a H. pylori Urease Breath Test ?
PPIs (2 weeks) | Antibiotics (4 weeks)
31
What is the most common method for testing H. pylori infection?
Faecal antigen test
32
What 2 things can a H. pylori faecal antigen test be used for?
Diagnosis of infection | Monitoring effect of irradication therapy
33
What must be stopped before a H. pylori faecal antigen test?
PPIs for 2 weeks
34
What are the 3 invasive tests for H. pylori?
Biopsy urease test Histology Culture
35
When is a biopsy culture of H. pylori taken?
If antibiotic sensitivities need to be determined
36
What should all peptic ulcer patients get as treatment?
Anti-secretory therapy | H. pylori test
37
If a <55y/o has a negative H. pylori test, what treatment should be given?
Immediate anti-secretory therapy
38
What is required in all >55y/o patients presenting with a peptic ulcer?
Endoscopic diagnosis with biopsy (to rule out cancer)
39
What is the investigation for any patient presenting with a possible peptic ulcer, and the presence of an ALARM Symptom?
Endoscopy
40
If a patient's peptic ulcer is not due to H. pylori or NSAIDs, what 2 things should be done?
Nutrition advice | Reducing co-morbidities
41
What lifestyle advice is particularly important in the treatment of peptic ulcers?
Stop smoking - allow mucosa to heal
42
What is the most common form of H. pylori eradication therapy?
Triple therapy for 1 week
43
How effective is triple therapy for H. pylori?
85% successful
44
What are the 2 common combinations for H. pylori triple therapy?
PPI, Amyoxycillin and clarithromycin PPI, Metronidazole and clarithromycin
45
What is the advantage and disadvantage of 2 week H. pylori eradication regimens?
Better eradication | Poorer compliance
46
When is quadruple therapy used in H. pylor?
When culture sensitivities need to be catered to
47
Why is compliance of eradication therapy so poor?
Side effects (nausea/diarrhoea) are common
48
What should be done if a peptic ulcer patient is still symptomatic post H. pylori eradication therapy?
Retest for H. pylori
49
What are the 2 options for anti-secretory therapy?
PPIs or H2RA (H2 receptor antagonists)
50
What type of anti-secretory therapy is better at healing DUs?
PPIs
51
What are 2 other, potential treatments for peptic ulcers (DUs)
Antacids and sucralfate
52
What are the 2 protocols for DU follow up?
If uncomplicated - no need to follow up If still symptomatic - then follow up
53
What is the post-therapy follow up for GUs?
Endoscope 6-8 weeks to ensure healing and no malignancy
54
What are the 5 complications of peptic ulcers?
Perforation - breaches peritoneum Penetration - burrows into adjacent organs Haemorrhage Stenosis of gastric outlet/duodenal obstruction Intractable pain - erodes nerve plexus
55
What condition can occur secondary to a haemorrhage of a peptic ulcer?
Anaemia
56
What type of peptic ulcer perforates more commonly?
DU
57
What are the 2 causes of gastric outflow obstruction that can occur secondary to a peptic ulcer?
Odema around an active ulcer | Scarring due to ulcer healing
58
What are the 2 more common causes of gastric outflow obstruction?
Crohn's or pancreatic tumour
59
What is the classic symptom of gastric outflow obstruction?
Vomiting without pain
60
Where are GUs commonly seen?
Lesser curvature, near the incisura | Also seen at the oesophago-gastric junction
61
Where are DUs most commonly seen?
Duodenal cap
62
What diameter are peptic ulcers?
2-10 cm
63
What is characteristic about ulcer edges?
Clear, punched out
64
What are the 3 microscopic layers of a peptic ulcer?
Necrotic, fibrinopurulent debris Base - inflamed granulation tissue Deepest layer - fibrotic scar tissue
65
What 2 genes, expressed by H. pylori, are associated with a greater incidence of peptic ulcers?
CagA | VacA
66
What do CagA and VagA induce?
IL-8 | => greater immune responce
67
What are the 2 gastric cancers that can occur due to H. pylori?
Gastric adenocarcinoma | Gastric B-Cell Lymphoma

RM - GI Conditions Profile (4 decks)

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