Peptic Ulcers (+H. Pylori) Flashcards
What is a peptic ulcer?
Ulceration of the mucosa of the stomach or duodenum
Which type of peptic ulcer is most common?
Duodenal ulcer 4X more common than peptic ulcer
What makes up the protective layer of the stomach?
Bicarbonate
Mucous
What can cause a peptic ulcer?
H. Pylori infection (most common) Increased stomach acid NSAIDs SSRI Blood group O Steroids Increased gastric emptying
What causes increased stomach acid?
Smoking Spicy foods Alcohol Caffeine Stress increased gastric emptying
How common is H. Pylori?
it is the cause of 90% of duodenal ulcers
Where are duodenal ulcers most commonly found?
right after the pyloric sphincter
Where are peptic ulcers most commonly found?
On the lesser curvature of the antrum
What are the signs and symptoms of peptic ulcers?
Epigastric pain Bloating Tenderness on palpation Nausea vomiting haematemesis coffee ground vomit malaena iron deficiency anaemia
Which ulcer causes weight gain?
Duodenal ulcer - better on eating food
Which ulcer causes weight loss?
Gastric ulcer - worse on eating food.
What effect does eating have on peptic ulcers?
gastric - worsens the pain
duodenal - improves the pain
What type of anaemia is a common presentation?
Iron deficiency anaemia - from chronic low level bleeding
What investigations can be done?
Upper endoscopy - biopsy, rapid urease test
What is the management for a NON H. Pylori ulcer?
High dose PPI
Monitoring using endoscopy
What are complications of peptic ulcers?
Bleeding Iron deficiency anaemia Perforation (peritonitis) - urgent surgical repair Scarring Strictures Pyloric stenosis
What are the symptoms of pyloric stenosis?
Upper abdominal pain distention reflux nausea vomiting Symptoms come on after eating
What type of bacteria is H.Pylori?
Gram negative
Releases urease which neutralises stomach pH and causes damage to the epithelium
What should be avoided before a rapid urease test?
PPIs
Antibiotics
To avoid a false positive
What is the treatment of H.Pylori infection?
Triple therapy 2x daily for 7 days:
Amoxicillin
Clarithromycin
PPI
If allergic to penicillin - use metronidazole
