Peptic ulcers, GORD

Question 1

What is a peptic ulcer?

Answer 1

An open sore in mucosa in or adjacent to an area which bears acid.

Question 2

Where are peptic ulcers most common?

Answer 2

Duodenum and stomach (duodenal 4x more common). (OHCM)

Question 3

What causes peptic ulcers?

Answer 3

H. pylori

NSAIDs

Smoking

Question 4

Give 5 symptoms of peptic ulcers.

Answer 4

Epigastric pain and tenderness

Gastric - worse while eating

Duodenal - worse while hungry

Bloating

Fullness after meals

Heartburn nausea

Question 5

What investigations would you do if you suspect peptic ulcers?

Answer 5

1. Upper GI endoscopy - stop PPI 2 weeks before.
2. Biopsy to exclude malignancy
3. C13 urea breath test to look for H. pylori
4. Stool antigen test to look for H. pylori.

(h. pylori most common cause of peptic ulcers)

Question 6

Describe the management of peptic ulcers.

Answer 6

Lifestle - decrease alcohol, smoking and aggravating foods. (OHCM)

If H. Pylori positive:

1. PPI eg omeprazole
2. Antibiotics - metronidazole, clarithromycin

If H. Pylori negative:

1. Stop NSAIDs (likely cause)
2. PPI eg lansoprazole
3. H2 blocker eg ranitidine (also decreases acid production)

(PTS)

Question 7

Give 5 symptoms or signs that would indicate referral for urgent endoscopy in someone with peptic ulcers.

Answer 7

Anaemia

Weight Loss

Anorexia

Recent onset/ progressive symptoms

melaena/haematemesis

swallowing difficulty

Question 8

What else could cause a similar picture to peptic ulcers?

Answer 8

Crohn’s

TB

lymphoma

pancreatic cancer

Question 9

Give 3 risk factors for gastric ulcers.

Answer 9

H pylori

Smoking

NSAIDs

Elderly

Question 10

Give 3 potential complications of peptic ulcers.

Answer 10

Bleeding

Perforation

Malignancy

Decreased gastric outflow

(OHCM)

Question 11

What happens in GORD?

Answer 11

Prolonged or recurrent reflux of gastric contents into the oesophagus.

Question 12

What causes GORD?

Answer 12

Smoking

alcohol

obesity

big meals

pregnancy

hernia

lower oesophageal sphincter hypotension

Question 13

Give 5 symptoms/ signs of GORD.

Answer 13

1. Heartburn when lying down and after meals
2. Painful swallowing
3. regurgitation
4. belching
5. increased salivation
6. Extra-esophageal symptoms: nocturnal asthma, chronic cough, laryngitis.

(PTS)

Question 14

Describe the management of GORD.

Answer 14

1. Lifestyle: stop smoking, decrease alcohol intake, large meals and hot drinks; raise the bed head; weight loss
2. For eosophagitis, PPIs eg omeprazole.
3. H2 receptor blockers eg ranitidine
4. Severe GORD may require laparoscopic surgery to decrease lower eosophageal sphincter pressure.

(OHCM)

Question 15

Give 3 potential complications of prolonged GORD.

Answer 15

1. Oesophagitis
2. Benign oesophageal stricture
3. Barrett’s oesophagus
4. ulcers
5. oesophageal cancer

(OHCM)

Question 16

What differential diagnoses should you consider in suspected GORD?

Answer 16

1. oesophagitis due to corrosives, NSAIDs, herpes, candida
2. Ulcers
3. Malignancy
4. Cardiac disease

Question 17

What investigations would you do if you suspect GORD?

Answer 17

1. Endoscopy if vomiting, GI bleeding, palpable mass >4 weeks, age >55, weight loss
2. Barium swallow may show hiatus hernia
3. 24h oesophageal pH monitoring

Question 18

Give 3 risk factors for GORD

Answer 18

Alcohol, obesity, smoking, coffee, pregnancy, big meals

Question 19

In addition to heartburn, give 3 symptoms which would indicate and urgent endoscopy.

Answer 19

ALARMS: Anaemia, loss of weight, anorexia, recent onset/progression of symptoms, melaena, haematemesis, swallowing difficulty.

Question 20

Give 2 investigations that could be used to diagnose a hiatus hernia.

Answer 20

Endoscopy, and if this is CI, barium swallow.