Peptic ulcers Flashcards
what are the risk factors for ulcers? (5)
smoking, alcohol consumption
chronic gastritis caused by H. Pylori infection (duodenal and gastric ulcers)
long term use of NSAIDs (risk is 5 times higher)
long term use of NSAIDs and glucorticoids
Zollinger Ellison Syndrome
how do you classify gastric ulcer?
lesser curvature and gastric antrum
what are the risk factors for gastric ulcers? (6)
H.pylori, smoking, NSAIDs, reflux of duodenal contents, delayed gastric emptying, stress, e.g. neurosurgery or burns, (Cushing’s or Curling’s ulcers). Symptoms:
what are the symptoms of gastric ulcers?
asymptomatic or epigastric pain relieved by antacids +- weight loss
what tests would you do?
- Upper GI endoscopy to exclude malignancy multiple biopsies from ulcer rim and base (histology, H.Pylori)
- Repeat endoscopy after 6-8 weeks to confirm healing and exclude malignancy.
what are features of duodenal ulcers?
Duodenal bulb, hypertrophy of Brunner glands. 4 fold commoner than GU.
what are major risk factors for duodenal ulcers?
H.Pylori, drugs (NSAIDs, steroids, SSRIs).
what are minor risk factors for duodenal ulcers?
Increased gastric secretion, increased gastric emptying (decreased duodenal pH), blood group 0, smoking.
what are the symptoms and signs of duodenal ulcers?
Asymptomatic or epigastric pain (relieved by antacids) +- weight loss.
Signs:
Epigastric tenderness.
how do you diagnose duodenal ulcers?
Upper gI endoscopy. Test for H.pylori. measure gastrin concentrations when off PPIs if Zollinger-Ellison syndrome is suspected.
what are the differential diagnosies for duodenal ulcers?
non-ulcer dyspepsia, duodenal chronics, TB, lymphoma, pancreatic cancer.
what is erosive gastritis?
acute mucosal inflammation of the stomach that does not extend beyond the muscular is mucosae.
what is the pathophysiology of ulcers?
- H pylori gastritis: increased acid secretion, decreased protective factors/mucus production
- NSAIDs: decreased protective prostaglandins
what are the general symptoms of ulcers?
epigastric pain often related to hunger, specific times of the day or food.
fullness after meals.
tender epigastrium
retrosternal pain (heart burn)
beware alarm symptoms
dyspepsia
pain releif with antacids
potential sign of internal bleeding (melena, hamatesis)
stool sample positive fro occult blood
hunger pain -> relieved after eating -> weight gain
nocturnal pain
what are symptoms of gastric ulcers?
pain increases shortly after eating -> weight loss
nocturnal pain in around 30-40% pateints
what are symptoms of duodenal ulcers?
pain increases 2-5 hours after eating.
what is the problem with taking NSAIDs?
Taking NSAIDs can often mask PUD symptoms until complications such as haemorrhage and perforation can occur.
what do you do in H. Pylori
If 55 years old or older:
Test and treat for h.pylori.
If positive give appropriate PPI and 2 antibiotic combination, e.g. lansoprazole.
Refer for urgent endoscopy all with dysphagia, as well as those over 55 with alarm symptoms or with treatment-refractory dyspepsia.
what is the treatment for H. Pylori?
Lifestyle:
- Decrease alcohol
- Tobacco
H. Pylori eradication:
• Triple therapy is 80-85% effective at eradication
Drugs to reduce acid:
PPIs are effective, e.g. lansoprazole or 8 GU weeks. H2 blockers have a place (ranitidine 300mg each night PO for 8 weeks
how do you treat drug induced ulcres>
Drug induced ulcers:
Stop drugs if possible. PPIs may be best for treating and preventing GI ulcers and bleeding patients on NSAID or antiplatelet drugs.
Misoprostol is an alternative with different SE.
If symptoms persist, re-endoscope, retest for Pylori, and reconsider differential diagnoses (e.g. gallstones)
what are the complications of uclers?
- Bleeding
- Perforation
- Malignancy
- Decreased gastric outflow.
