ULCERS AND APPENDICITIS Flashcards
what are peptic ulcers?
a sore on the lining of your stomach, small intestine or oesophagus
what are gastric ulcers?
ulcers in the stomach
where do gastric ulcers tend to develop?
on the lesser curvature of the stomach
where do duodenal ulcers tend to develop?
just after the oyloric phincter
outline the key characteristics of benign ulcers?
smooth, round margins
smooth and clean bases
hamptons line
seen on lesser curvature
outline the key characteristics of malignant ulcers?
ireegular margins
necrotic base
carmans meniscus sign
seen on greater curvater
what are some causes of peptic ulcers?
H. pylori infection
NSAIDs
zollinger ellison syndrome
why can H.pylori cause ulcers?
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.
why can NSAIDs cause ulcers?
they inhibit cyclooxygenase which reduces the synthesis of inflammatory prostaglandins leaving the gastric mucosa susceptible to damage
why can zollinger-ellison syndrome cause ulcers?
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
what are some complications of ulcers?
bleeding
perforation
nausea
vomiting
what are symptoms of ulcers?
epigastric pain worse with eating (only gastric not duodenal which is why they are associated with weight loss)
bloat
belching
vomiting
how do we distinguish between gastric and duodenal ulcers from the history
gastric are worse with eating = weight loss
duodenal are not
how can be treat ulcers
antibiotics
PPIs (-prazole e.g. omeprazole)
avoid NSAIDs, alcohol, tobacco, caffeiene
surgery
what are aphthous ulcers?
canker sores - painful inflammatory lesions on the inside of the mouth
what are herpetiform ulcers?
typically affect women, start as clusters of tiny discrete ulcers, recur so frequently = difficulty eating and drinking
what do aphthous ulcers look like?
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
outline the pathophysiology of appendicitis?
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
what are some complications of appendicitis?
ruptured appendix
peritonitis
periappendiceal abscess
subphrenic abscess
