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Gastroenterology > Peptic Ulcers > Flashcards

Peptic Ulcers Flashcards

1
Q

What is the definition of a peptic ulcer?

A

A defect in gastric or duodenal mucosa with a diameter of at least .5cm and depth that penetrates through the muscularis mucosae

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2
Q

What is the definition of as gastric ulcer?

A

A peptic ulcer of the gastric mucosa, typically located along the lesser curvature in the transitional portion between corpus and antrum

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3
Q

What is the definition of a duodenal ulcer?

A

A peptic ulcer of the duodenal mucosa, usually located on the anterior or posterior wall of the duodenal bulb

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4
Q

What is the median age for developing a peptic ulcer?

A

18-30 years of age

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5
Q

What are the 2 most common causes of peptic ulcer disease?

A

Helicobacter pylori
Chronic NSAID use

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6
Q

How many cases of duodenal and gastric ulcers is H pylori associated with?

A

Duodenal - 40-70%
Gastric - 25-50%

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7
Q

What are the associated risk factors for peptic ulcer disease?

A

Smoking
Heavy alcohol use
Glucocorticoids
Caffeine
Diet
Anxietysgtress
PTSD
Genetic factors

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8
Q

What are some rare causes of PUD?

A

Acid hypersecretory state (gastrinoma for example)
Non NSAID medication eg acetaminophen, chemo
Infections eg EBV, CMV
Radiation
Illicit drug use eg cocaine
Systemic inflammatory disease eg chrons disease

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9
Q

What is gastric juice composed of?

A

HCL
Peposinogen

Intrinsic factor
Mucus

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10
Q

What prevents the gastric juice from damaging the stomach lining?

A

Secretion of mucus and HCO3

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11
Q

What can cause the ulcer formation?

A

When either the protective mechanisms are disrupted and or excessive acids or pepsin are secreted

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12
Q

What is the function of the parietal cells?

A

Secrete HCl and intrinsic factor

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13
Q

What stimulates the parietal cells?

A

Acetylcholine, histamine and gastrin

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14
Q

What inhibits parietal cells?

A

Prostaglandins
Somatostatin

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15
Q

What is the function of the mucosal cells?

A

Secrete protective mucus

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16
Q

What stimulates the mucosal cells?

A

Acetylcholine, prostaglandin (which inhibits HCl production) and Secretin

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17
Q

What is the purpose of chief cells?

A

Secrete pepsinogen

18
Q

What stimulates the chief cells

A

Acetylcholine, gastric, secretin and vasoactive intestinal polypeptide

19
Q

How does H pylori infection cause a gastric ulcer formation?

A

Hpylori secretes urease -> conversion of urea to Ammonia -> alkalinisation of acidic environment -> survival of bacteria in the gastric lumen. Bacterial colonisation and attachment to epithelial cells -> release of cytotoxins -> disruption of the mucosal barrier and damage to underlying cells

20
Q

How does H pylori infection cause a duodenal ulcer formation?

A

Hpylori inhibits somatostatin secretion -> increased gastrin secretion -> increased acid production ->? Excess acid delivery to duodenum. Direct spread of Hpylori to duodenum -> Inhibition of duodenal HCO3 secretion -> acidification and insufficient neutralisation off duodenal contents

21
Q

How do NSAID’s lead to peptic ulcer formation? (Pathophysiology)

A

Inhibits COX1 and COX2 -> decrease in prostaglandin production -> erosion of the gastric mucosa. Decrease mucosal blood flow. Inhibit mucosal cell proliferation.

22
Q

How does acid hypersecretioon lead to peptic ulcer formation? (Pathophysiology)

A

Acid hypersecretion and increased gastrin production -> increased acid secretion and parietal cell mass -> delivery of excessive acid to the duodenum

23
Q

Clinical features of peptic ulcer?

A

Up to 70% asymptomatic (more common in those who are due to NSAID use)
Epigastric abdominal pain - gnawing or burning in nature. Related to meal intake depending on location of ulcer
Belching
Indigestion
GER
Nausea and or vomiting
Bloating/abdominal fullness

24
Q

Which clinical features are common in gastric and peptic ulcer? §

A

Dyspepsia - postprandial heaviness, early satiety, gnawing aching burning epigastric pain
Pain relief with antacids
Potential signs of internal bleeding eg anemia, hematemesis
Stool sample p=positive for occult blood

25
Q

What are the differences in clinical features of gastric and duodenal ulcer?

A

Gastric - pain increases shortly after eating -> weight loss. Nocturnal pain less common
Duodenal - pain is relieved with foods intake -> weight gain. Pain increases after 2-5 hours of food ingestion. Nocturnal pain more common

26
Q

What is a subtype of a peptic ulcer?

A

Stress ulcer

27
Q

What is a stress ulcer associated with?

A

Erosive gastritis

28
Q

What is the initial diagnosis approach for peptic ulcer?

A

Look for underlying cause eg NSAID’s.
CBC and BMP (basic metabolic panel) if suspicion for occult bleeding

29
Q

What does a basic metabolic panel check?

A

Serum concentrations of -
Sodium
Potassium
Chloride
Bicarbonate
Urea nitrogen
Creatinine
Glucose

30
Q

What is the diagnosis approach for patients <60 and without red flags for dyspepsia

A

Begin with non invasive testing for H pylori infection - urea breath test and stool antigen test

31
Q

What is the diagnosis approach for patients >60/45 years with high gastric cancer prevalence, patients with red flags for dyspepsia and patients unresponsive to empiric medical therapy eg hpylori eradication therapy

A

Refer directly for esopaghogastroduiodenoscopy

32
Q

What is Ruthie most accurate test to confirm peptic ulcer diagnosis?

A

Esophagogastroduodenoscopy

33
Q

What are the other purposes of an EGD?

A

Malignancy screening - to differentiate between PUD and gastric cancer
Invasive hpylori testing
Hemostasis treatment

34
Q

What are the differences between benign and malignant gastroduodenal ulcers?

A

(Look at picture in gallery)

35
Q

What are the objectives of treatment of a peptic ulcer?

A

Removing symptoms
Healing the ulcerous cratere
Preventing reoccurrence
Preventing complications
Treatment of complications

36
Q

What are the treatments for peptic ulcer?

A

Dietary management - Quit smoking and alcohol. Stoop NSAID us. 8 hours of sleep and small regular meals

37
Q

What is the medical treatment of Peptic ulcer?

A

Duodenal ulcer and Hpylori - eradicate HP and antisecretory drugs
Duodenal ulcer and HP and NSAID - eradicate HP and antisecretory drugs and prostaglandins
DU and NSAID - antisecretory drugs and prostaglandins

38
Q

Which antibiotics are used for the treatment of HP?

A

Amoxicillin 500mg x4/day
Clarithromycin 500-1500mg/day
Tetracycline 500mg x4/day
Metronidazole 2500mg x4/day

39
Q

What are the antisecretory drugs used?

A

PPI’s - omeprazole 40mg/dauy
Pantoprazole 40mg/day
Rabeprazole 40mg/day
Lansoprazole 40mg/day

40
Q

What are some Histamine receptor blocking drugs?

A

Ranitidine 150mg x2/day
Famotidine 20mg x2/day
Nizatidine 150mg x2/day

41
Q

What is the modified Johnson classification of peptic ulcers?

A

Type 1 - ulcer along body of stomach, most often along lesser curvature at inciusra angularis along locus minoris resistantiae

Type 2 - ulcer in body in combination with duodenal ulcers. Associated with acid hypersecretion

Type 3 - in pyloric channel within 3cm of pylorus. Associated with acid hypersecretion

Type 4 - proximal gastroesophageal ulcer

Type 5 - can occur throughout stomach. Associated with chronic NSAID use eg aspirin

Gastroenterology (28 decks)

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