PUD Ulcers Flashcards
what is PUD?
punched out round holes in either stomach or duodenum
What are the 2 types called?
mc and lc?
gastric - LC
Duodenal - MC
What happens In PUD?
Pathology?
Normally a protective layer in stomach comprised of mucus + bicarbonate to neutralise acid, secreted by stomach mucosa
Protective layer is broken down by meds + bacteria, increased stomach acid
Gastric
this is mostly at?
causes?
Lesser curve of stomach - left gastric artery perforated
H.pylori
NSAIDS
Zollinger Ellison syndrome
Gastrin secreting tumour
what is the gastrin secreting tumour triad?
Pancreatic tumour
gastric acid hyper secretion
wide spread peptic ulcers
Sx of gastric?
Epigastric pain - WORSE on eating, BETTER between meals + with antacids
*typically weight loss
Duodenal
this is mostly at?
causes?
mostly at D1/D2 posterior wall - gastroduodenal artery perforated
H.PYLORI!
NSAIDS
ZE syndrome
by far MC is H.pylori –> NSAIDs plus ZE more applicable to gastric ulcers
Sx of duodenal?
epigastric pain
WORSE between meals
BETTER with food
*typically weight gain
Sx for both?
n+v
haematemesis
coffee ground vomit (digested blood)
dyspepsia (indigestion)
Melaena (tarry black stools)
Fe anemia
Dx for both?
if red flags and no red flags?
no red flags (55+, haematemsis / melon, anemia, dysphagia)
Non invasive tests =
C-Urea breath test (UBT)
Stool antigen test - Both detect H.Pylori
If red flag = urgent endoscopy + biopsy
what would be seen in the endoscopy and biopsy in duodenal ulcer?
BRUNNER’S GLAND HYPERTROPHY
- more mucuc production
if testing for H.pylori, what must they be off?
PPI for 2 weeks (all ulcers)
otherwise false negative
Tx for both?
stop NSAID and if H.pylori +ve , given TRIPLE THERAPY (CAP)
Clarythromycin, amoxicillin, PPI
(If PUD found, rescope 6-8 weeks later)
If they have a penicillin allergy, what is replaced?
Amoxicillin replaced with metronidazole
complication of gastric ulcer?
Bleeding
rupture left gastric artery
less common
