ULCERS AND APPENDICITIS

Question 1

what are peptic ulcers?

Answer 1

a sore on the lining of your stomach, small intestine or oesophagus

Question 2

what are gastric ulcers?

Answer 2

ulcers in the stomach

Question 3

where do gastric ulcers tend to develop?

Answer 3

on the lesser curvature of the stomach

Question 4

where do duodenal ulcers tend to develop?

Answer 4

just after the oyloric phincter

Question 5

outline the key characteristics of benign ulcers?

Answer 5

smooth, round margins
smooth and clean bases
hamptons line
seen on lesser curvature

Question 6

outline the key characteristics of malignant ulcers?

Answer 6

ireegular margins
necrotic base
carmans meniscus sign
seen on greater curvater

Question 7

what are some causes of peptic ulcers?

Answer 7

H. pylori infection
NSAIDs
zollinger ellison syndrome

Question 8

why can H.pylori cause ulcers?

Answer 8

These bacteria colonize in the gastric mucosa and release adhesions which help them adhere to foveolar cells, and proteases which cause damage to mucosal cells.

Question 9

why can NSAIDs cause ulcers?

Answer 9

they inhibit cyclooxygenase which reduces the synthesis of inflammatory prostaglandins leaving the gastric mucosa susceptible to damage

Question 10

why can zollinger-ellison syndrome cause ulcers?

Answer 10

its a neuroendocrine tumour that secretes abnormal amounts of gastrin so parietal cells release excess hydrochloric acid. these ulcers tend to develop in the first portion of the duodenum, or even distal duodenum or jejunum

Question 11

what are some complications of ulcers?

Answer 11

bleeding
perforation
nausea
vomiting

Question 12

what are symptoms of ulcers?

Answer 12

epigastric pain worse with eating (only gastric not duodenal which is why they are associated with weight loss)
bloat
belching
vomiting

Question 13

how do we distinguish between gastric and duodenal ulcers from the history

Answer 13

gastric are worse with eating = weight loss

duodenal are not

Question 14

how can be treat ulcers

Answer 14

antibiotics
PPIs (-prazole e.g. omeprazole)
avoid NSAIDs, alcohol, tobacco, caffeiene
surgery

Question 15

what are aphthous ulcers?

Answer 15

canker sores - painful inflammatory lesions on the inside of the mouth

Question 16

what are herpetiform ulcers?

Answer 16

typically affect women, start as clusters of tiny discrete ulcers, recur so frequently = difficulty eating and drinking

Question 17

what do aphthous ulcers look like?

Answer 17

Initially they are a small, raised bump but as they heel they turn into an ulcer covered by a fibrous membrane cap which looks yellowish-white or grey. They are typically surrounded by a characteristic red halo

Question 18

outline the pathophysiology of appendicitis?

Answer 18

an obstruction occurs
fluid builds up as lumen is always secreting mucus and fluids
pressure increases and appendiz presses on visceral nerve fibres causing pain
flora and bacteria are now trapped and are free to multiply so the immune system recruits WBCs = pus accumulates in the appendix
eventually it was expand so much it will push on small blood vessels supplyign the appendix so O2 can reach it - cells start to die so cannot produce mucus anymore and bacteria can then invade the walls of the appendix making them weak - can lead to rupture

Question 19

what are some complications of appendicitis?

Answer 19

ruptured appendix
peritonitis
periappendiceal abscess
subphrenic abscess