Peptic Ulcer Disease Flashcards

1
Q

def

A

ulceration of areas of the GI tract caused by exposure to gastric acid + pepsin

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2
Q

where are peptic ulcers commonly found

A

1 gastric ulcers

2 duodenal ulcers

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3
Q

aetiology

A

imbalance between damaging acid + pepsin and protective mucosal mechanisms

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4
Q

associations/risk factors

A
1 common
-helicobacter pylori (95% of duodenal, 70% of gastric)
-NSAID use
2 rare
-zollinger-ellison syndrome
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5
Q

what is zollinger-ellison syndrome

A

tumours in pancreas and duodenum

tumours secrete hormone gastrin which causes the stomach to produce excess gastric acid

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6
Q

epi

A

common

males>females

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7
Q

what age group do duodenal ulcers commonly affect

A

30yrs

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8
Q

what age group do gastric ulcers commonly affect

A

50yrs

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9
Q

history

A

1 epigastric abdominal pain

2 haematemesis/ melaena

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10
Q

what is the pain like in peptic ulcer disease

A

epigastric abdominal pain

  • relieved by antacids
  • worse immediately after eating - gastric
  • worse hours after eating - duodenal
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11
Q

examination

A

1 epigastric tenderness

2 signs of complications (anaemia)

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12
Q

what are the ALARM Symptoms for PUD

A
Anaemia
Loss of weight
Anorexia
Recent onset/progressive symptoms
Melaena/haematemesis
Swallowing difficulty
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13
Q

how would H. pylori be treated

A

triple therapy
1 PPI
2 amoxicillin
3 clarithromycin

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14
Q

investigations

A
1 bloods
-FBC (anaemia)
-amylase (exclude pancreatitis)
-secretin test
2 endoscopy
-gastric ulcer biopsy to exclude malignancy
3 rockall scoring
-for severity in GI bleed
-<3 good prognosis
->8 bad prognosis
4 testing for H.pylori
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15
Q

what is the secretin test

A

to diagnose zollinger-ellison syndrome

secretin will cause a rise in gastrin in ZE patients but not controls

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16
Q

how would you test for h. pylori

A

1 (13)C urea breath test

-radiolabelled urea given by mouth to patient, H.pylori metabolizes urea, (13)C detected in expired air

17
Q

what is more common, gastric or duodenal ulcers

A

duodenal ulcers are 4 times as common

18
Q

major risk factors for duodenal ulcers

A

1 h. pylori
2 NSAIDs
3 steroids

19
Q

major risk factors for gastric ulcers

A

1 h.pylori
2 smoking
3 NSAIDs

20
Q

management

A
1 endoscopy
-haemostasis by injection sclerotherapy (coagulation of blood)
2 surgical
-single perforated ulcers sewn together
-chronic/many ulcers partial gastrectomy
3 medical
-h. pylori triple therapy
-if not associated with h. pylori use PPIs/H2-antagonists
-stop NSAID use
21
Q

complications

A

1 haemorrhage (haematemesis, meleana)
2 perforation
3 pancreatitis

22
Q

prognosis

A

good as peptic ulcers can be treated with h. pylori eradication