Peptic Ulcers Flashcards
Why should peptic ulcers be biopsied and and OGD should be performed?
They can develop into cancer- so upper endoscopy with biopsy should be done
What symptoms do peptic ulcers cause?
Dyspepsia Pain Gastric ulcers worsens when eating Duodenal ulcers relieved with eating Nausea
What is an infective cause of peptic ulcers?
H.Pylori
What medication puts people at greater risk of developing ulcers?
NSAIDs
What are some complications of peptic ulcers?
Upper GI Bleeding- if it erodes into a vessel
Cancer- malignant change with prolonged inflammation
Peritonitis if perforation of bowel
What ulcers are more likely to cause upper GI bleeding?
Posterior duodenal ulcers as proximal to gastric artery
What is the most common type of gastric cancer?
Adenocarcinoma
MALT lymphoma can also form- as with H.Pylori infection
What are some symptoms of stomach cancer?
Weight Loss Haematemesis Malaena Feeling full early when eating meals Abdominal pain IDA
What is the investigation of choice for peptic ulcers?
OGD- biopsy must be taken to investigate for cancerous changes
What are ALARMS for upper gi cancer?
Anaemia IDA Loss of weight Anorexia Recent onset Malaena Swallowing difficulty
What is the treatment for H.Pylori?
Triple therapy
Omeprazole + Amoxicillin + Clarithromycin
Or if penicillin allergy
Omeprazole + Clarithromycin + Methrotrexate
What investigations can be done for H.Pylori?
Non Invasive- Breath Test, Xtool Antigen, Serology
Invasive- (Require ODG) CLO Test,Culture, Microscopy
What should you test for with any peptic or duodenal ulcer?
Cancerous change so do biopsy (esp for gastric cancers)
H.Pylori infection
What needs to be done if a gastric malignancy is suspected on OGD?
Biopsy for histological analysis
Lymph node biopsy
CT for TNM staging
What is the treatment to eradicate H.PYlori?
Omeprazole + Amoxicillin + Clarithromycin
Or Omeprazole + Metronidazole + Clarithromycin (If penicillin allergy)
For 14 days
For seven days and eradication testing needs to be done.
What is the most common cause of peptic ulcer disease?
H.Pylori- it’s a gram negative bacteria that produces urease enzyme (tested for with CLO test)
Why does H.Pylori need to be eradicated?
Increased risk of peptic ulcer disease and gastric cancer
What tests can be done for H.Pylori using endoscopy?
CLO Test
Culture
Microscopy
What colour change is seen on the CLO test?
Yellow to pink
What non-invasive test can be done for H.Pylori?
Carbon breath test
Stool antigen test
Serology
PPIs should be stopped as they can cause a false negative
What needs to be stopped before testing for H.Pylori?
PPIs as they can cause a false negative result
What is tested for with H.Pylori serology?
IgG antibodies
What needs to be done after treatment for H.Pylori infection?
Review to see if symptoms have improved and can check for eradication with Carbon breath test if they haven’t
Why do NSAIDs increase risk of peptic ulcers?
Decreased production of prostaglandins involved in mucosal lining protection
What should you consider adding when prescribing NSAIDs for anyone?
Consider adding a PPI
Add a PPI if there is any history of peptic ulcer disease
What is Zollinger Ellison syndrome?
Gastrin secreting tumour that causes increased acid production by the parietal cells of the stomach
Leads to multiple peptic ulcers forming
Where are the tumours located in Zollinger Ellison syndrome?
Duodenum
Pancreas
What is cancer syndrome in Zollinger Ellison syndrome associated with?
Multiple Endocrine Neoplasia 1-
Pituitary, Pancreas and Parathyroid tumors
What cancer drugs might cause peptic ulcers?
Chemotherapy reduces the rate of cell turner and this can cause irritation of the GI tract and can lead to peptic ulcers
Which type of ulcers does pain worse when eating?
Gastric
Duodenal ulcers improve with eating
What are stress ulcer?
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)
What antidepressant is associated with causing duodenal ulcers?
SSRIs
What is more common out of peptic and duodenal ulcers?
Peptic ulcers
What are some differentials for causes of dyspepsia?
Dudoenal ulcer Gastric ulcer Gastritis Zollinger Ellison syndrome Gastric malignancy H.Pylori infection
What is a typical dose of lansoprazole?
30mg
What is a typical dose of ranitidine?
300mg
