Treatment of peptic ulcers Flashcards

1
Q

Recall the 2 main presenting features of a peptic ulcer

A
  1. Epigastric pain

2. Burning sensation after meals

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2
Q

Recall the 3 investigations done for peptic ulcers, and which of these is the gold standard

A

Gold standard = endoscopy
Carbon urea breath test
Stool-antigen test for H pylori

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3
Q

Describe the basis of a carbon urea breath test and the implication of a positive result

A

Give patient loads of unique carbon isotope-urea and if you get increased levels of specific-isotope CO2 being exhaled = positive for H pylori

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4
Q

How can the history differentiate between a peptic and peptic and duodenal ulcer?

A

Pain at meal times = peptic (gastric acid) whereas if meal relieves pain = duodenal (pyloric sphincter closure)

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5
Q

`What is the most common cause of peptic ulcer?

A

Bacterial infection with H Pylori

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6
Q

In around what % of the population is H pylori commensal?

A

50%

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7
Q

How does H pylori infection cause development of a peptic ulcer? (2 steps”

A
  1. It produces urease which can break down the protective mucous layer
  2. It releases exotoxins at the epithelium, leading to IL8 release and local inflammation
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8
Q

How do NSAIDS cause development of peptic ulcers?

A

Directly cytotoxic, reducing mucous production and causing IL8 release at epithelium

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9
Q

What is the first line treatment for H pylori + peptic ulcers?

A

Amoxycillin combined with Clarithromycin/ metronidazole, and a PPI for 7-14 days

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10
Q

Describe the treatment of a recurrent peptic ulcer?

A
  1. Amoxycillin, clarithromycin and metronidazole given together with quinolone
  2. Bismuth
  3. Omeprazole (PPI) for 4-12 weeks
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11
Q

How do PPIs reduce gastric acid secretion?

A

Inhibit proton pump on apical side of parietal cells

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12
Q

If NSAID cannot be removed, how is an NSAID-induced peptic ulcer treated?

A

PPI or H2 antagonist

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13
Q

Why would an H2 receptor antagonist be useful in peptic ulcer treatment?

A

H2 receptors on parietal cells stimulate proton pump to increase acid secretion

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14
Q

Recall the function of prostaglandins in the stomach

A

PROTECTIVE

  1. Increase blood supply to stimulate mucous production
  2. Increase HCO3- production
  3. Decrease acid production
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15
Q

Recall the risk factors for peptic ulcers

A
  1. Stress
  2. genetic
  3. Lifestyle (diet/ alcohol/ smoking)
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16
Q

Recall 3 molecules that inhibit gastric acid production

A
  1. Secretin
  2. GIP
  3. Somatostatin
17
Q

Recall the site of production on somatostatin and its role in stomach regulation

A

Produced in D cells of stomach

Role: When stimulated by PNS, inhibits histamine release –> less acid produced

18
Q

Recall the site of production on gastrin and its role in stomach regulation

A

Produced in G cells of stomach

  1. Stimulates H cells to produce histamine
  2. Directly triggers acid production by parietal cells
19
Q

Give an example of a histamine antagonist used in peptic ulcer therapy

A

Ranitidine