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GI (Gastroenterology) > The Stomach - Peptic Ulcer Disease > Flashcards

The Stomach - Peptic Ulcer Disease Flashcards

1
Q

What is Peptic Ulcer Disease?

A

Ulceration of the mucosa of the stomach (gastric) or duodenum (duodenal).

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2
Q

Epidemiology of Peptic Ulcer Disease.

A

Duodenal ulcers are 4x commoner.

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3
Q

Associations of H. pylori Infection (4).

A
  1. Peptic Ulcer Disease.
  2. Gastric Carcinoma.
  3. B Cell Lymphoma of MALT Tissue.
  4. Atrophic Gastritis.
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4
Q

Aetiology of Ulceration (2B).

A
  1. Breakdown of the Protective Layer of the Stomach and the Duodenum by medications or H. pylori.
  2. Increase in Stomach Acid.
    2B. Zollinger-Ellison syndrome (Gastrin-Secreting Tumour = High Gastrin Levels).
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5
Q

What is the protective layer made up of in the stomach?

A

Mucus and Bicarbonate secreted by the stomach mucosa.

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6
Q

Give 5 causes of increased stomach acid secretion.

A
  1. Stress.
  2. Alcohol.
  3. Caffeine.
  4. Smoking.
  5. Spicy Foods.
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7
Q

Give 4 medications that can cause breakdown of the protective layer of the stomach.

A
  1. NSAIDs.
  2. SSRIs.
  3. Corticosteroids.
  4. Bisphosphonates.
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8
Q

Pathophysiology of Peptic Ulcer Disease (4).

A
  1. H. pylori - gram-negative aerobic bacteria spread by oral-oral or faecal-oral transmission.
  2. Enters gastric mucosa to avoid acidic environment - exposes the epithelial cells underneath to stomach acid so it can enter and using flagella.
  3. Ammonia produced to neutralise stomach acid - it damages epithelial cells.
  4. Release cytotoxins e.g. CagA Toxin to disrupt gastric mucosa.
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9
Q

Clinical Features of Peptic Ulcer Disease (5).

A
  1. Epigastric Discomfort or Pain.
  2. Nausea and Vomiting.
  3. Dyspepsia.
  4. Upper GI Bleed - Haematemesis, Coffee-Ground Vomit and Melaena.
  5. Iron-Deficiency Anaemia (constant bleeding).
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10
Q

Effect of Eating on Pain in Peptic Ulcer Disease (2).

A
  1. Worsening Pain in Gastric Ulcers.

2. Improving Pain in Duodenal Ulcers.

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11
Q

Investigations of Peptic Ulcer Disease (3).

A
  1. Diagnosis - Endoscopy and Rapid Urease (CLO) Test to check for H. pylori.
  2. Consider Biopsy during Endoscopy to exclude Malignancy.
  3. H. pylori test for anyone with dyspepsia - 2 weeks without PPI and 4 weeks without antibacterial for accurate result.
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12
Q

Types of H. pylori Tests (3).

A
  1. Urea Breath Test - Radiolabelled C-13.
  2. Stool Antigen Test.
  3. Rapid Urease Test - Endoscopy : CLO (Campylobacter-like Organism) Test - a small biopsy is taken and urea is added. If H. pylori is present, urease enzymes convert the urea into ammonia. pH is tested.
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13
Q

Management of Peptic Ulcer Disease (3).

A
  1. Same as GORD if not H. pylori i.e. High-Dose PPIs.
  2. Endoscopy Monitoring.
  3. Eradication of H. pylori.
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14
Q

Eradication of H. pylori (3).

A
  1. TRIPLE THERAPY : PPI + 2 Antibiotics (Amoxicillin + Clarithromycin/Metronidazole) for 7 days twice daily.
  2. Check success (not necessary) using Urea Breath Test.
  3. If failed, repeat another TRIPLE THERAPY with the other of Clarithromycin/Metronidazole (or in allergy, Tetracycline/Quinolone).
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15
Q

Complications of Peptic Ulcer Disease (4).

A
  1. Upper GI Bleed (75%) : Acute (Melaena, Haematemesis) or Chronic (Anaemia).
  2. Perforation - Acute Abdomen and Peritonitis - Surgical Repair (because the ulcer erodes through all layers of the wall).
  3. Scarring and Strictures of Muscle and Mucosa (healing by fibrosis - presents as obstruction).
  4. Malignant Change (biopsy any suspected peptic ulcer in oesophagus or stomach).
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16
Q

What is the significance of scarring and strictures in Peptic Ulcer Disease?

A

Narrowing of the pylorus - pyloric stenosis.

17
Q

How are Upper GI Bleeds commonly caused with Peptic Ulcer Disease?

A

The gastroduodenal artery can be the source of a significant GI bleed.

18
Q

What are the 3 key features of chronic inflammation?

A
  1. Persistent Tissue Injury.
  2. On-going inflammatory response to limit the damage (macrophages, lymphocytes, plasma cells).
  3. Healing by Fibrosis (scarring).
19
Q

What feature of ulcerating carcinomas is not seen in benign ulcers?

A

Rolled edge.

GI (Gastroenterology) (32 decks)

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