Peptic Ulcers Flashcards
What is peptic ulcer disease?
Lesions in the lining of the GI mucosa caused by the action of pepsin and stomach acid.
They occur in the stomach (gastric ulcer) or in the first part of the duodenum (duodenal ulcers).
What are the main causes of peptic ulcer disease?
- Helicobacter Pylori
- NSAIDs
How does H. Pylori cause peptic ulcers?
o Increases acid production
o Mainly affects the antrum of the stomach which stimulates the G-cells and suppression of D-cells
o Disruption of mucosal defence due to inflammation
How do NSAIDs cause peptic ulcers?
o Cytotoxic to epithelial cells causing topical injury which disrupts barrier
o Inhibits COX1 receptor which decreases mucous secretions, epithelial blood flow (impairs repair mechanisms) and impairs platelet function
o Inhibits COX2 receptor which inhibits angiogenesis (impairs repair mechanisms)
o Increased acid production
What are the risk factors for peptic ulcer disease?
- Smoking
- Drinking alcohol above recommended intake
- Family Hx of peptic ulcers
- Physical stress
- Hypersecretory syndromes which increase production of stomach acid
What are the symptoms of peptic ulcers?
Gastric ulcers:
o Epigastric pain worse when eating
Duodenal ulcers:
o More common
o Epigastric pain when hungry, relieved by eating
General: • Dyspepsia • Loss of appetite • Nausea and vomiting • Weight loss
What are the complications of a gastric ulcer?
- Bleeding ulcers
- Perforation
- Gastric outlet obstruction (GOO)
What can indicate a bleeding ulcer?
o Haematemesis
o Coffee-coloured vomit
o Melaena
o Iron-deficiency anaemia
What can indicate perforation?
o Severe abdominal pain
o Causes an acute abdomen and peritonitis
What can indicate GOO?
- Epigastric abdominal pain
- Postprandial vomiting
What investigations do you do for H. Pylori?
- Urea breath test
* Stool antigen test
How long should you wait until H. Pylori re-testing?
6-8 weeks after starting treatment
What are the differentials for peptic ulcers?
• Gastritis Inflammation of the gastric mucosa • Non-ulcer dyspepsia Indigestion and epigastric pain but normal gastric mucosa on endoscopy • Pancreatitis • Cholecystitis
How do you treat H. Pylori?
Triple therapy
- PPI
- Amoxicillin
- Clarithromycin or metronidazole
Abs 7 days
What do you give for H. Pylori if the person is allergic to penicillins?
PPI + Clarithromycin + Metronidazole
