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A - MSRA Gastrointestinal [7] > [11] Peptic Ulcer Disease > Flashcards

[11] Peptic Ulcer Disease Flashcards

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
Q

What is involved in the medical management of PUD?

A

OTC antacids
H. Pylori eradication
Acid suppression

26
Q

Give 2 examples of OTC antacids

A

Gaviscon

Mg trisilicate

27
Q

How might H. Pylori eradication be done?

A

PAC 500/PMC 250

28
Q

Give two examples of acid suppressants that may be used in the medical management of PUD?

A

PPIs, e.g. Lansoprazole

H2RAs, e.g. Ranitidine

29
Q

What is an important concept in surgery for PUD?

A

If there is no acid, there is no ulcer

30
Q

What is acid secretion in the stomach stimulated by?

A

Gastrin from antral G cells

Vagus nerve

31
Q

What are the surgical options for PUD?

A

Vagotomy
Antrectomy with vagotomy
Subtotal gastrectomy

32
Q

What are the types of vagotomy in PUD?

A

Truncal

Selective

33
Q

How does a truncal vagotomy work in PUD?

A

Reduces acid secretion directly and through decreased gastrin

34
Q

What is the problem with a truncal vagotomy?

A

Prevents pyloric sphincter relaxation

35
Q

What is the result of a truncal vagotomy preventing pyloric sphincter relaxation?

A

It must be combined with pyloroplasty or gastroenterostomy

36
Q

What is a pyloroplasty?

A

Widening of the pylorus

37
Q

What happens in a selective vagotomy?

A

The vagus nerve is only denervated where it supplies the lower oesophageal sphincter and stomach, but the nerves of Laterjet are left intact

38
Q

What do the nerves of Laterjet supply?

A

Pylorus

39
Q

What happens in an antrectomy with vagotomy?

A

The distal half of the stomach is removed, and an anastomosis is made

40
Q

What are the potential approaches to anastomosis in antrectomy?

A

Billroth 1

Billroth 2

41
Q

What happens in a billroth 1 anastomosis for antrectomy?

A

The stomach is anastomosed directly into the duodenum

42
Q

What happens in a billroth 2 anastomosis for antrectomy?

A

The stomach is anastomosed to a small bowel loop, with the duodenal stump oversewn

43
Q

When might a subtotal gastrectomy be performed for PUD?

A

Occasionally performed for Zollinger-Ellison

44
Q

What are the physical complications of surgery for PUD?

A 
Increased risk of gastric cancer
Reflux or bilous vomiting
Abdominal fullness
Stricture 
Stump leakage
45
Q

What happens to the complication of reflux or bilious vomiting over time?

A

It improves

46
Q

What are the metabolic complications of surgery for PUD?

A

Dumping syndrome
Blind loop syndrome
Vitamin deficiency
Weight loss

47
Q

What are the symptoms of dumping syndrome?

A

Abdomen distention
Flushing
Nausea and vomiting
Fainting and sweating

48
Q

What are the early effects of dumping syndrome?

A

Osmotic hypovolaemia

49
Q

What are the late effects of dumping syndrome?

A

Reactive hypoglycaemia

50
Q

What are the symptoms of blind loop syndrome?

A

Malabsorption

Diarrhoea

51
Q

What happens in blind loop syndrome?

A

There is overgrowth of bacteria in the duodenal stump

52
Q

Why can surgery for PUD cause vitamin deficiency?

A

Decreased action of parietal cells causes B12 deficiency

Bypassing proximal SB causes iron and folate deficiency

53
Q

What can vitamin deficiency caused by surgery for PUD lead to?

A

Osteoporosis

54
Q

Why can surgery for PUD lead to weight loss?

A

Malabsorption and decreased calorie intake

A - MSRA Gastrointestinal [7] (44 decks)

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