complications of peptic ulcers

Question 1

what are the most important contributing factors to peptic ulcers ?

Answer 1

H.pylori
NSAIDs
acid and pepsin

Question 2

what are the most important protective factors ?

Answer 2

mucus
bicarbonate mucosal blood flow 
prostaglandins
hydrophobic layer 
epithelial renewal

Question 3

what is considered the gold standard of h.pylori infection ?

Answer 3

histological identification

Question 4

what are the methods of detection of H.pylori ?

Answer 4

histological identification 
microbiological culture 
urease breath test 
rapid urease test 
serology for H.pylori antigen 
stool antigen test

Question 5

which of the H.pylori tests require prior preparation ?

Answer 5

stool antigen test

urease breath test ( need to strop antibiotics and anti-acid medications)

Question 6

what are one of the methods of detection of blood in the stool ?

Answer 6

guaic stool test

Question 7

what is a succussion splash ?

Answer 7

is a sloshing sound heard through a stethoscope during sudden movement of the patient on abdominal auscultation

Question 8

what are the differential diagnosis ?

Answer 8

MI 
neoplasm 
pancreatitis 
pancreatic cancer 
diverticulitis 
GERD

Question 9

what is the treatment plan for h.pylori ?

Answer 9

triple therapy:

Amoxicillin + Clarithomycin + Proton Pump Inhibitor

Question 10

what is the treatment plan for a non h.pylori peptic ulcer?

Answer 10

proton pump inhibitor
H2 receptor antagonists to assist ulcer healing
treatment plan for up to 8 weeks

Question 11

what are the complications of peptic ulcer disease ?

Answer 11

bleeding
perforation
obstruction

Question 12

what is the presentation of gastrointestinal bleeding ?

Answer 12

tarry stool or coffee ground emesis

Question 13

what is the presentation of perforation ?

Answer 13

history of PUD
air under diaphragm
abdominal tenderness

Question 14

what is the presentation of gastric outlet obstruction ?

Answer 14

pain worsening with food 
non-billous vomiting 
hypokalemia 
hyponatremia 
weight loss

Question 15

what is the treatment for gastric outlet obstruction ?

Answer 15

endoscopic balloon dilatation

truncal vagotomy

Question 16

what is the most common complication of peptic ulcers ?

Answer 16

bleeding peptic ulcer

Question 17

what is the most likely prognosis of bleeding peptic ulcer?

Answer 17

self-limiting

Question 18

what is the next best step in management in melena or hematemsis ?

Answer 18

1.in a stable patient :
consider IV PPI therapy, along with early endoscopy within 24 hours along with early discharge 
2.in an unstable patient:
urgent endoscopy 
endostasis + IV PPI infusion

Question 19

If there is re-bleeding in an unstable patient with hematemesis or melena what is the next best step in management ?

Answer 19

consider :
repeat endostasis
mesenteric angiography/embolisation
surgery

Question 20

what are the levels of bleeding in peptic ulcers ?

Answer 20

• on a microscopic level
• mild
• moderate
• severe

Question 21

what is the clinical presentation of a bleeding peptic ulcer ?

Answer 21

hematemesis
melena / tarry stool
manifestations of progressive shock

Question 22

how to exclude false hematemesis ?

Answer 22

examination of the nose and pharynx

Question 23

what is the most common cause of hematemesis ?

Answer 23

bleeding varicies

Question 24

what is an important cause of hematemesis that must be excluded ?

Answer 24

portal hypertension

Question 25

what are the investigations required for bleeding peptic ulcer?

Answer 25

when the general condition of the patient is stabilized then an upper GI endoscopy

Question 26

when would testing for hematocrit ad haemoglobin be appropriate ?

Answer 26

hematocrit and haemoglobin is only useful a few hours after haemdilution

Question 27

what is the treatment for a bleeding peptic ulcer?

Answer 27

most of these cases stop spontaneously | conservative treatment should always be considered

Question 28

when should PPIs be started ?

Answer 28

they should be delayed until the first endoscopy is performed

Question 29

what are the endoscopic treatment options for bleeding peptic ulcers ?

Answer 29

injections with adrenaline heat probes haemostatic clips

Question 30

what is the next step in management if endoscopic therapy fails in a bleeding peptic ulcer ?

Answer 30

selective arterial embolisation prior to surgical intervention

Question 31

what are the indications of endoscopis treatment ?

Answer 31

ulcer seen to be actively bleeding | stigmata of recent bleeding

Question 32

when there is severe bleeding in a bleeding peptic ulcer which artery is most likely to be affected ?

Answer 32

gastroduodenal artery which can be fatal

Question 33

what are the signs indicating perforated PU ?

Answer 33

air under diaphragm on Xray

Question 34

what is the treatment for Perforated PU?

Answer 34

resuscitate with fluids crystalloids | IV ab if there is bacterial peritonitis

Question 35

what are the two types of obstructing peptic ulcer ?

Answer 35

acute from inflammatory swelling | chronic from cicatrix

Question 36

what are the complications of obstructing peptic ulcer ?

Answer 36

Antral stenosis | respiratory infection due to aspiration of vomit