Peptic ulcers Flashcards
What is a peptic ulcer?
Ulceration of the mucosa of the stomach (gastric ulcer) OR duodenum (duodenal ulcer)!
Which type of peptic ulcer is more common?
Duodenal ulcer
When do duodenal ulcers characteristically cause pain?
Worse when hungry –> relieved when eating
When do gastric ulcers characteristically cause pain?
When eating!
a) What is the protective layer in the stomach?
b) Where is it excreted?
a) Mucus and bicarbonate
b) gastric mucosa (which gets damaged)
What breaks down the protective layer in the stomach? (common causes)
(1) NSAIDs or steroids
(2) H.Pylori
What things increase acid production?
- stress
- alcohol
- caffeine
- smoking
- spicy food
Presentation of peptic ulcer?
1) epigastric pain/discomfort
2) dyspepsia
3) N&V
4) bleeding –> haematemesis, ‘coffee ground’ vomit, melaena
5) Iron deficiency anaemia
Diagnosis of peptic ulcer?
Endoscopy w/
- rapid urease test (CLO) for H.Pylori
- biopsy for malignancy
Management of peptic ulcer disease w/ negative H.Pylori?
(As GORD)
- PPIs (omeprazole) until healed
- Endoscopy surveillance
4 medications that cause cause peptic ulcers?
1) NSAIDs
2) steroids
3) SSRIs
4) bisphosphonates
Most common risk factor for peptic ulcer?
Helicobacter Pylori (95% duodenum, 75% gastric)
Management of peptic ulcer disease w/ positive H.Pylori?
Triple therapy:
- 1x PPI
- 2x antibiotics (amoxicillin + clarithromycin)
1st line investigation to look for H.Pylori?
urea breath test OR stool antigen
Complications of peptic ulcers?
1) Bleeding - from ulcer
2) Perforation –> ‘acute abdomen’ –> peritonitis!
3) Scarring and strictures (pyloric stenosis!)
