Peptic ulcer disease

Question 1

What is dyspepsia

Answer 1

Non specific symptoms related to upper GI

May relate to food, bloating, umbilical discomfort

Question 2

Alarm symptoms with dyspepsia

Answer 2

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms or hematemesis
Swallowing difficulty

Question 3

Signs to elicit

Answer 3

Tender epigastrium
Abdominal mass
Supraclavicular nodes

Question 4

Managing new dyspepsia

Answer 4

FBC
FOBT

> 55 years or ALARM->Upper GI endoscopy

Stop drugs causing dyspepsia (NSAIDS, nitrates, anticholinergic, TCAs, CCB)
Lifestyle changes-> weight loss, smoking cessation, raise bed, small regular meals. Avoid hot drinks, spicy foods, alcohol, citrus, chocolate and eating test for H. pylori ->if +ve Eradication therapy and review in 4 weeks. If no improvement->UBT->if eradicated, do upper GI endoscopy
If initially -ve H pylori-> PPI for 4 weeks, if not improved will have longer dose and can consider upper GI endoscopy

Question 5

What is more common gastric ulcers or duodenal ulcers

Answer 5

Duodenal

Question 6

Major risk factors for duodenal ulcers

Answer 6

H pylori+++
NSAIDs, aspirin, steroids

Minor->+gastric acid, +gastric emptying, blood group O and smoking

Question 7

Clinical presentation of duodenal ulcer

Answer 7

Epigastric pain before meals, at night

Relieved by eating or drinking milk

Question 8

If doing an upper GI endoscopy, should PPIs be stopped

Answer 8

Yes, 2 weeks before

Question 9

In what age group do gastric ulcers typically occur

Answer 9

Elderly

Question 10

Risk factors for gastric ulcers

Answer 10

H pylori
Smoking
NSAIDs
Reflux of duodenal contents
Delayed gastric emptying
Stress-->neurosurgery = Cushing's ulcer, or burns->curling's ulcer

Question 11

Symptoms of gastric ulcer

Answer 11

May be asymptomatic

Epigastric pain related to meals, relieved with antacids +/= weight loss

Question 12

What is done at upper GI endoscopy

Answer 12

Visualise
Multiple biopsies
Cytology

Question 13

How long is PPI treatment for GU compared to DU

Answer 13

GU->8 weeks

DU->4 weeks

Question 14

Differential diagnosis of dyspepsia

Answer 14

Non-ulcer dyspepsia
OsophagitisGORD
DU/GU
Gastric malognancy
Duodenitis
Gastritis

Question 15

Pathogenesis of GU related to NSAID use, intracranial, stress ulcers

Answer 15

NSAIDs-> -ve prostaglandins which normaly +mucin production and +vascular perfusion, therefore these are reduced

Intracranial->+activity of vagal nuclei= +gastric acid

Stress ulcers->splanchnic vasoconstriction

Question 16

Complications of gastric ulcers

Answer 16

Perforation
Obstruction
Bleeding

Question 17

How does obstruction occur in gastric ulcers

Answer 17

Most commonly in chronic
Edema and scarring
Puloric channel ulcers

May present as incapacitating crampy abdominal pain, rarely total obstruction/intractable vomiting