Peptic Ulcer Disease Flashcards
how would you initially treat an upper GI bleed?
A to E assessment A - if patent move on to B B - could give oxygen if sats are low C - if hypotensive, will need fluids etc
if a patient came in with a bleeding peptic ulcer and was on anti-hypertensives, how might you change the dose of them while in hospital?
If patient is hypovolaemic from bleeding from the ulcer it is best to omit the medications while in hospital as they decrease BP further
How do NSAIDs contribute to peptic ulceration?
by inhibiting COX-1 it inhibits prostaglandins which stimulate gastric mucous secretion and maintain gastric blood flow and promote platelet aggregation
gaviscon is a mixture of an antacid and alginate. what does the alginate part do?
increases viscosity of stomach contents which reduces reflux of stomach acid into oesophagus.
when should antacids and alginates be taken and why?
after food for a prolonged effect otherwise they are cleared rapidly by the stomach
antacids such as aluminium salts (e.g. aluminium hydroxide) should not be taken with which classes of drugs and why?
NSAIDs and tetracyclines as it reduces their absorption - can give by spreading doses apart by 2hrs
what lifestyle and pharmacological factors can exacerbate dyspepsia?
smoking, alcohol, NSAIDs
what is the pharmacological management of non-ulcer dyspepsia?
PPI trial for 4-6weeks
you would do an upper GI endoscope for people with ALARM symptoms, what are these?
Anaemia Loss of weight Anorexia Recent onset of progressive symptoms Melaena
how would you test for helicobacter pylori?
urea breath test or stool antigen test
what is the treatment for someone with an uncomplicated peptic ulcer who is H.pylori positive?
eradication therapy = 7 day course of:
- PPI + amoxicillin + clarithromycin, or
- PPI + metronidazole + clarithromycin (if penicillin allergy)
what is the first line approach for someone with a peptic ulcer that is bleeding acutely?
ABC approach followed by endoscopic intervention:
diathermy,
clipping,
laser coagulation or,
injection with adrenaline to stop bleeding
what should be given post-endoscope in a person who has had a peptic ulcer bleed stopped?
IV PPI for 72hrs then chance to oral therapy.
This reduces re-bleeding rates and thus reduces a need for further surgery. PPIs reverse the deactivation of the coagulation system and platelet aggregation in the gut mucosa that occurs when the local pH falls below 4
if eradication therapy is needed for h.pylori, why should statins be omitted?
statins interacte with microlide antibiotics (e.g. clarithromycin)
if metronidazole is given for eradication therapy of h.pylori, what is it important to tell patients they must avoid?
avoid alcohol becasue it interacts with metronidazole. need to be 72hrs clear of metronidazole before having alcohol again
