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SPM- Gastroenterology > Peptic Ulcers > Flashcards

Peptic Ulcers Flashcards

1
Q

Why should peptic ulcers be biopsied and and OGD should be performed?

A

They can develop into cancer- so upper endoscopy with biopsy should be done

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2
Q

What symptoms do peptic ulcers cause?

A 
Dyspepsia
Pain
Gastric ulcers worsens when eating
Duodenal ulcers relieved with eating 
Nausea
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3
Q

What is an infective cause of peptic ulcers?

A

H.Pylori

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4
Q

What medication puts people at greater risk of developing ulcers?

A

NSAIDs

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5
Q

What are some complications of peptic ulcers?

A

Upper GI Bleeding- if it erodes into a vessel
Cancer- malignant change with prolonged inflammation
Peritonitis if perforation of bowel

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6
Q

What ulcers are more likely to cause upper GI bleeding?

A

Posterior duodenal ulcers as proximal to gastric artery

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7
Q

What is the most common type of gastric cancer?

A

Adenocarcinoma

MALT lymphoma can also form- as with H.Pylori infection

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8
Q

What are some symptoms of stomach cancer?

A 
Weight Loss
Haematemesis 
Malaena
Feeling full early when eating meals
Abdominal pain
IDA
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9
Q

What is the investigation of choice for peptic ulcers?

A

OGD- biopsy must be taken to investigate for cancerous changes

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10
Q

What are ALARMS for upper gi cancer?

A 
Anaemia IDA
Loss of weight
Anorexia
Recent onset
Malaena
Swallowing difficulty
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11
Q

What is the treatment for H.Pylori?

A

Triple therapy
Omeprazole + Amoxicillin + Clarithromycin
Or if penicillin allergy
Omeprazole + Clarithromycin + Methrotrexate

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12
Q

What investigations can be done for H.Pylori?

A

Non Invasive- Breath Test, Xtool Antigen, Serology

Invasive- (Require ODG) CLO Test,Culture, Microscopy

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13
Q

What should you test for with any peptic or duodenal ulcer?

A

Cancerous change so do biopsy (esp for gastric cancers)

H.Pylori infection

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14
Q

What needs to be done if a gastric malignancy is suspected on OGD?

A

Biopsy for histological analysis
Lymph node biopsy
CT for TNM staging

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15
Q

What is the treatment to eradicate H.PYlori?

A

Omeprazole + Amoxicillin + Clarithromycin

Or Omeprazole + Metronidazole + Clarithromycin (If penicillin allergy)

For 14 days

For seven days and eradication testing needs to be done.

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16
Q

What is the most common cause of peptic ulcer disease?

A

H.Pylori- it’s a gram negative bacteria that produces urease enzyme (tested for with CLO test)

17
Q

Why does H.Pylori need to be eradicated?

A

Increased risk of peptic ulcer disease and gastric cancer

18
Q

What tests can be done for H.Pylori using endoscopy?

A

CLO Test
Culture
Microscopy

19
Q

What colour change is seen on the CLO test?

A

Yellow to pink

20
Q

What non-invasive test can be done for H.Pylori?

A

Carbon breath test
Stool antigen test
Serology

PPIs should be stopped as they can cause a false negative

21
Q

What needs to be stopped before testing for H.Pylori?

A

PPIs as they can cause a false negative result

22
Q

What is tested for with H.Pylori serology?

A

IgG antibodies

23
Q

What needs to be done after treatment for H.Pylori infection?

A

Review to see if symptoms have improved and can check for eradication with Carbon breath test if they haven’t

24
Q

Why do NSAIDs increase risk of peptic ulcers?

A

Decreased production of prostaglandins involved in mucosal lining protection

25
Q

What should you consider adding when prescribing NSAIDs for anyone?

A

Consider adding a PPI

Add a PPI if there is any history of peptic ulcer disease

26
Q

What is Zollinger Ellison syndrome?

A

Gastrin secreting tumour that causes increased acid production by the parietal cells of the stomach

Leads to multiple peptic ulcers forming

27
Q

Where are the tumours located in Zollinger Ellison syndrome?

A

Duodenum

Pancreas

28
Q

What is cancer syndrome in Zollinger Ellison syndrome associated with?

A

Multiple Endocrine Neoplasia 1-

Pituitary, Pancreas and Parathyroid tumors

29
Q

What cancer drugs might cause peptic ulcers?

A

Chemotherapy reduces the rate of cell turner and this can cause irritation of the GI tract and can lead to peptic ulcers

30
Q

Which type of ulcers does pain worse when eating?

A

Gastric

Duodenal ulcers improve with eating

31
Q

What are stress ulcer?

A

Ulcers that come on acutely due to stresses in the body

Alcohol, chemo, NSAIDs, decreased mucosal blood flow (trauma/sepsis), curling ulcers (due to hypovolaemia with burns)

32
Q

What antidepressant is associated with causing duodenal ulcers?

A

SSRIs

33
Q

What is more common out of peptic and duodenal ulcers?

A

Peptic ulcers

34
Q

What are some differentials for causes of dyspepsia?

A 
Dudoenal ulcer
Gastric ulcer
Gastritis
Zollinger Ellison syndrome
Gastric malignancy
H.Pylori infection
35
Q

What is a typical dose of lansoprazole?

A

30mg

36
Q

What is a typical dose of ranitidine?

A

300mg

SPM- Gastroenterology (13 decks)

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