[11] Peptic Ulcer Disease Flashcards

(54 cards)

1
Q

What is the main symptom of peptic ulcer disease?

A

Epigastric pain

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2
Q

What are the features of the pain in duodenal ulcers?

A

Occurs before meals and at night

Relieved by eating

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3
Q

What are the features of the pain from gastric ulcers?

A

Worse on eating

Relieved by antacids

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4
Q

What are the risk factors for peptic ulcer disease?

A
H. Pylori
NSAIDs
Steroids
Smoking
Alcohol
Stress
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5
Q

What is a Cushing’s ulcer associated with?

A

Head injury

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6
Q

What is a Curling’s ulcer associated with?

A

Burns

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7
Q

How do peptic ulcers appear?

A

Usually punched out ulcers

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8
Q

What are peptic ulcers usually on a background of?

A

Chronic inflammation

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9
Q

How common are gastric ulcers compared to duodenal ulcers?

A

Duodenal ulcers are 4x more common

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10
Q

Where do duodenal ulcers occur?

A

Duodenal cap (1st part of duodenum)

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11
Q

Where do gastric ulcers most commonly occur?

A

Lesser curvature of gastric antrum

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12
Q

What are the potential complications of gastric ulcers?

A

Haemorrhage
Perforation
Gastric outflow obstruction
Malignancy

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13
Q

How can haemorrhage caused by PUD present?

A

Haematemesis or melaena

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14
Q

What can haemorrhage caused by PUD lead to?

A

Iron deficiency anaemia

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15
Q

What can perforation of PUD lead to?

A

Peritonitis

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16
Q

What are the symptoms of gastric outflow obstruction?

A

Vomiting
Colic
Distention

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17
Q

Why is PUD a risk factor for malignancy?

A

Because of the association of both with H. Pylori infection

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18
Q

Does malignant transformation occur in PUD?

A

Probably not

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19
Q

How is PUD investigated?

A

Bloods
C13 breath test
OGD
Gastrin levels

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20
Q

What needs to be checked in bloods in PUD?

A

FBC

Urea

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21
Q

What needs to be done before an OGD is performed in PUD?

A

Stop PPIs >2 weeks before

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22
Q

What can be done on OGD in PUD?

A

CLO/urease test for H. pylori

Biopsy of all ulcers to check for malignancy

23
Q

When are gastrin levels done in PUD?

A

If Zollinger-Ellison syndrome is suspected

24
Q

What is involved in the conservative management of PUD?

A
Loose weight 
Stop smoking
Reduce alcohol
Avoid hot drinks and spicy foot
Stop drugs such as NSAIDs and steroids
OTC antacids
25
What is involved in the medical management of PUD?
OTC antacids H. Pylori eradication Acid suppression
26
Give 2 examples of OTC antacids
Gaviscon | Mg trisilicate
27
How might H. Pylori eradication be done?
PAC 500/PMC 250
28
Give two examples of acid suppressants that may be used in the medical management of PUD?
PPIs, e.g. Lansoprazole | H2RAs, e.g. Ranitidine
29
What is an important concept in surgery for PUD?
If there is no acid, there is no ulcer
30
What is acid secretion in the stomach stimulated by?
Gastrin from antral G cells | Vagus nerve
31
What are the surgical options for PUD?
Vagotomy Antrectomy with vagotomy Subtotal gastrectomy
32
What are the types of vagotomy in PUD?
Truncal | Selective
33
How does a truncal vagotomy work in PUD?
Reduces acid secretion directly and through decreased gastrin
34
What is the problem with a truncal vagotomy?
Prevents pyloric sphincter relaxation
35
What is the result of a truncal vagotomy preventing pyloric sphincter relaxation?
It must be combined with pyloroplasty or gastroenterostomy
36
What is a pyloroplasty?
Widening of the pylorus
37
What happens in a selective vagotomy?
The vagus nerve is only denervated where it supplies the lower oesophageal sphincter and stomach, but the nerves of Laterjet are left intact
38
What do the nerves of Laterjet supply?
Pylorus
39
What happens in an antrectomy with vagotomy?
The distal half of the stomach is removed, and an anastomosis is made
40
What are the potential approaches to anastomosis in antrectomy?
Billroth 1 | Billroth 2
41
What happens in a billroth 1 anastomosis for antrectomy?
The stomach is anastomosed directly into the duodenum
42
What happens in a billroth 2 anastomosis for antrectomy?
The stomach is anastomosed to a small bowel loop, with the duodenal stump oversewn
43
When might a subtotal gastrectomy be performed for PUD?
Occasionally performed for Zollinger-Ellison
44
What are the physical complications of surgery for PUD?
``` Increased risk of gastric cancer Reflux or bilous vomiting Abdominal fullness Stricture Stump leakage ```
45
What happens to the complication of reflux or bilious vomiting over time?
It improves
46
What are the metabolic complications of surgery for PUD?
Dumping syndrome Blind loop syndrome Vitamin deficiency Weight loss
47
What are the symptoms of dumping syndrome?
Abdomen distention Flushing Nausea and vomiting Fainting and sweating
48
What are the early effects of dumping syndrome?
Osmotic hypovolaemia
49
What are the late effects of dumping syndrome?
Reactive hypoglycaemia
50
What are the symptoms of blind loop syndrome?
Malabsorption | Diarrhoea
51
What happens in blind loop syndrome?
There is overgrowth of bacteria in the duodenal stump
52
Why can surgery for PUD cause vitamin deficiency?
Decreased action of parietal cells causes B12 deficiency | Bypassing proximal SB causes iron and folate deficiency
53
What can vitamin deficiency caused by surgery for PUD lead to?
Osteoporosis
54
Why can surgery for PUD lead to weight loss?
Malabsorption and decreased calorie intake