**ACC (Y4)** Abdominal: Peptic Ulcers Flashcards
(26 cards)
What is a peptic ulcer?
a break in the superficial epithelial cells penetrating down to the muscular mucosa of either the stomach or duodenum
how are erosions differ from peptic ulcers?
erosions are superficial breaks in the mucosa alone
ulcers are superficial breaks penetrating down tot he muscular layer
where are duodenum ulcers most commonly found?
duodenal cap
where are stomach ulcers most commonly found?
most commonly seen on the lesser curve near the incisura - but can be found anywhere in the stomach
which is more common, stomach or duodenal ulcers?
duodenum ulcer is more common
what risk factors are associated with peptic ulcers?
- H.Pylori infection
- NSAID drug use
- Zollinger-Ellison syndrome
- Smoking
- Alcohol
Why is there a considerable geographical variation with peptic ulcer disease?
peptic ulcer disease being more prevalent in developing countries related to the high H. pylori infection
In the developed world the percentage of NSAID-induced peptic ulcers is increasing, as the preva- lence of H. pylori declines.
what are clinical features of peptic ulcers?
- Recurrent, burning epigastric pain.
- Pain of DU and GU may be relieved by antacids.
- Nausea.
- Anorexia/weight loss.
- Fatty food intolerance.
- Heartburn.
- Feeling of fullness, bloating or belching.
- Melaena/haematemesis.
- Swallowing difficulty.
When does duodenum ulcer pain classically occur?
night time
what is Odynophagia and what is it suggestive of?
pain during the act of swallowing and is suggestive of oesophagitis
what does persistent/severe pain relating to a peptic ulcer suggest?
complications such as penetration into other organs
back pain suggests a penetrating posterior ulcer
which conditions present in a similar way to a peptic ulcer?
- GORD
- Gallstones
What investigations would you conduct if you suspected a peptic ulcer?
Test for H.Pylori using any of the following:
- urea breath test
- stool antigen test
- blood test
endoscopy/gastroscopy to confirm presence of an ulcer
What is the treatment for a patient that tests positive for H.Pylori?
Proton pump inhibitor (PPI) twice daily and amoxicillin 1g twice daily and either clarithromycin 500mg twice-dailyor metronidazole 400mg twice-daily. (for 7 days)
antibiotic and PPI
what is the role of antibiotics in the treatment of H.Pylori infection?
kill H. pylori.
what is the role of a proton pump inhibitor (PPI) in the treatment of a peptic ulcer?
block acid production and promote healing
what is the role of a H2 receptor antagonist in the treatment of a peptic ulcer?
reduce acid production
what is the role of antacids in the treatment of a peptic ulcer?
neutralize stomach acid
what are some common over the counter antacids?
gaviscon
What is the treatment for a patient that tests positive for H.Pylori, but has a penicillin allergy?
If the person is allergic to penicillin, offer a 7-day triple therapy regimen of:
A PPI twice daily and clarithromycin 500 mg twice daily and metronidazole 400 mg twice-daily.
NB: the British National Formulary (BNF) recommends using clarithromycin 250 mg twice-daily for this regimen.
what are the complications if peptic ulcers are left untreated?
- internal bleeding
- infection
- gastric obstruction
- perforation
how can you prevent peptic ulcers?
- infection control (hand washing, preparing food well)
- use NSAIDs with caution
what is a refractory ulcer?
an ulcer that has failed to heal
what reasons may a peptic ulcer fail to heal?
- Over production of stomach acid (e.g. Zollinger-Ellison syndrome).
- An infection other than H. pylori.
- Stomach cancer.
- Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn’s disease.
