Dyspepsia and Peptide Ulcer Disease

Question 1

dyspepsia

Answer 1

epigastric pain or burning

postprandial fullness

early satiety

Question 2

dyspepsia - causes

Answer 2

ORGANIC
peptic ulcer disease, drugs, gastric cancer

FUNCTIONAL
idiopathic
structural disease and functional gut disorders

Question 3

dyspepsia - examination

Answer 3

epigastric tenderness

COMPLICATED
cachexia
mass
evidence gastric outflow obstruction
peritoneum

Question 4

peptic ulcer disease

Answer 4

cause of organic dyspepsia

pain predominant dyspepsia (to back)
often also nocturnal

aggravated or relieved by eating
gastric =pain
duendenal = no pain

relapsing and remitting chronic illness

family history

Question 5

peptic ulcer disease - causes

Answer 5

h.pylori
90% of DU
60% of GU

NSAIDs

Question 6

h.pylori

Answer 6

acquired in infancy
gram -ve microaerophilic flagellated bacillus

oral-oral/faecal oral spread

consequences arrive later in life

Question 7

h.pylori - consequences

Answer 7

no pathology

peptide ulcer disease

gastric cancer

Question 8

h.pylori - diagnosis

Answer 8

gastric biopsy
urease test
histology
culture/sensitivity

urease breath test

FAT (faecal antigen test)

serology (IgA antibiotics) - not accurate with increasing patient age

Question 9

h.pylori increases pH of its microenvironment

Answer 9

produces ammonium bicarbonate

catalysed by urease

Question 10

treatment of PUD

Answer 10

all antisecretory therapy PPI

all tested for presence of H.pylori
+ve = eradicate and confirm
-ve = antisecretory therapy

withdraw NSAIDs

lifestyle

Question 11

eradication therapy

Answer 11

triple therapy for 1 week commonest

PPI + amoxycillin + clarithromycin

2 week regimens
higher eradication rates
poorer compliance

dual therapy

quadruple therapy

Question 12

complications of PUD

Answer 12

anaemia
bleeding
perforation
gastric outlet/duodenal obstruction - fibrotic scar