Peptic ulcer disease

Question 1

RFs
H pylori
Drugs
- […]
- […]
- corticosteroids
- bisphosphonates
[…]-[…] syndrome: gastrin-secreting tumour

Answer 1

H pylori
Drugs
- NSAIDs
- SSRIs
- corticosteroids
- bisphosphonates
Zollinger-Ellison syndrome: gastrin-secreting tumour

Question 2

Peptic ulcer vessel affected

Answer 2

Gastroduodenal artery

Question 3

Invx for perforated ulcer

Answer 3

upright (‘erect’) chest x-ray - pneumoperitoneum

Question 4

H pylori mechanism of survival (2)

Answer 4

chemotaxis away from low pH areas, using its flagella to burrow into the mucous lining to reach the epithelial cells underneath
secretes urease → urea converted to NH3 → alkalinization of acidic environment → increased bacterial survival

Question 5

H pylori mechanism of pathophysiology

Answer 5

releases bacterial cytotoxins (e.g. CagA toxin) → disruption of gastric mucosa

Question 6

Triple therapy

Answer 6

proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole)

if penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin