Peptic Ulcers (+H. Pylori) Flashcards

1
Q

What is a peptic ulcer?

A

Ulceration of the mucosa of the stomach or duodenum

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2
Q

Which type of peptic ulcer is most common?

A

Duodenal ulcer 4X more common than peptic ulcer

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3
Q

What makes up the protective layer of the stomach?

A

Bicarbonate

Mucous

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4
Q

What can cause a peptic ulcer?

A
H. Pylori infection (most common)
Increased stomach acid 
NSAIDs
SSRI
Blood group O
Steroids
Increased gastric emptying
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5
Q

What causes increased stomach acid?

A
Smoking
Spicy foods
Alcohol
Caffeine 
Stress
increased gastric emptying
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6
Q

How common is H. Pylori?

A

it is the cause of 90% of duodenal ulcers

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7
Q

Where are duodenal ulcers most commonly found?

A

right after the pyloric sphincter

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8
Q

Where are peptic ulcers most commonly found?

A

On the lesser curvature of the antrum

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9
Q

What are the signs and symptoms of peptic ulcers?

A
Epigastric pain
Bloating
Tenderness on palpation
Nausea
vomiting
haematemesis
coffee ground vomit 
malaena 
iron deficiency anaemia
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10
Q

Which ulcer causes weight gain?

A

Duodenal ulcer - better on eating food

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11
Q

Which ulcer causes weight loss?

A

Gastric ulcer - worse on eating food.

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12
Q

What effect does eating have on peptic ulcers?

A

gastric - worsens the pain

duodenal - improves the pain

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13
Q

What type of anaemia is a common presentation?

A

Iron deficiency anaemia - from chronic low level bleeding

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14
Q

What investigations can be done?

A

Upper endoscopy - biopsy, rapid urease test

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15
Q

What is the management for a NON H. Pylori ulcer?

A

High dose PPI

Monitoring using endoscopy

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16
Q

What are complications of peptic ulcers?

A
Bleeding
Iron deficiency anaemia
Perforation (peritonitis) - urgent surgical repair
Scarring
Strictures 
Pyloric stenosis
17
Q

What are the symptoms of pyloric stenosis?

A
Upper abdominal pain
distention
reflux
nausea
vomiting
Symptoms come on after eating
18
Q

What type of bacteria is H.Pylori?

A

Gram negative

Releases urease which neutralises stomach pH and causes damage to the epithelium

19
Q

What should be avoided before a rapid urease test?

A

PPIs
Antibiotics

To avoid a false positive

20
Q

What is the treatment of H.Pylori infection?

A

Triple therapy 2x daily for 7 days:
Amoxicillin
Clarithromycin
PPI

If allergic to penicillin - use metronidazole