Dyspepsia and Peptic Ulcer Disease Flashcards Preview

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Flashcards in Dyspepsia and Peptic Ulcer Disease Deck (44):
1

Define dyspepsia

Indigestion

2

What are some of the symptoms of dyspepsia

Epigastric pain or burning
Postprandial fullness
Early satiety
Combination or separate symptoms

3

What are the structures of the foregut and where does it start and end

Oesophagus
Stomach
Duodenum
Pancreas
Gallbladder
Starts at the cricopharyngeus to the ampulla of Vater

4

Describe the epidemiology of Dyspepsia

Very common (20-40% global)
No consistence association with sex/age/ socioeconomic status/ smoking or alcohol
More common if H pylori infected
More common if using NSAIDs
Overlap with IBS / GORD

5

What are the 2 main classes of causes of Dyspepsia and how common is each one

Organic (25%) and Functional (75%)

6

What are some of the organic causes?

Peptic ulcer disease
Drugs (NSAIDs, COX2 inhibitors)
Gastric cancer

7

What are some of the functional causes?

Idiopathic
Associated with other functional gut disorder such as IBS
No evidence of culprit structural disease

8

What is it really important to differentiate between in diagnosing dyspepsia

Heartburn, reflux or dyspepsia

9

What is the only examination finding in dyspepsia

Epigastric tenderness only

10

If the dyspepsia is complicated, what else can it cause

Cachexia
Mass
Evidence of gastric outflow obstruction
Peritonism

11

How do we manage a patient with no alarm symptoms

Non invasive test and treat strategy
Test for H pylori

12

If a patient is H pylori positive what course of action should be taken?

Prescribe course of antibiotics

13

If H pylori negative what course of action should be taken?

Use PPI and other acid suppression and monitor the patient symptomatically if under 55
If the patient is over 55, we use ore active treatment and consider a referral to specialist

14

What other factors can affect functional dyspepsia?

Visceral hypersensitivity (MAIN CONTRIBUTOR)
Disrupted gut-immune interactions
Abnormal upper GI motor and reflex functions
Psychosocial factors (gut changes with stress)
Genetic factors
Altered brain-gut interactions

15

What is peptic ulcer disease

Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum

16

What are the common syptoms of peptic ulcer disease?

Pain radiating to the back
Nocturnal pain
Aggrevated or relieved by eating
Relapsing and remitting chronic illness
More common in lower socio-economic groups
Past family history

17

What are the 2 main causes of peptic ulcers

H pylori and NSAIDs

18

What is happening to the ratio of NSAID: H pylori?

It is rising

19

Describe H pylori

Acquired in infancy
Gram negative microaerophilic flagellated bacillus
Oral-oral/ faecal oral spread
Consequences of infection do not arise until later in life

20

What are the 2 main consequences of H Pylori

Peptic Ulcer disease
Gastric cancer

21

Describe the prevalence of H Pylori around the world

In the developing world, the prevelance is very high at an early age
In the Western world, there is a greater prevalence as the age increases. Older generations were brought up in a less clean and more poorly sanitised environments.
There is a higher prevalence of H pylori in lower social economic areas

22

What are the 2 different outcomes of an H Pylori infection

An increase in acid secretion of a decrease in acid secretion.
An increase causes an increased risk of duodenal ulcer
A decrease causes atrophy which results in Gastric Cancer

23

What is a typical endoscopic finding of a duodenal NSAID induced ulcer

Multiple white erosions all on one side of the tube

24

What do we need to worry about if an ulcer is irregular in shape and deep with raw edges?

Cancer - biopsy is required!

25

What is a typical sign of a gastric ulcer?

Raw edges on an ulcer

26

What 4 ways can we diagnose H pylori infection?

Gastric Biopsy
Urease Breath Test
Faecal Antigen test
Serology (IgA antibodies)

27

What might give you a false reading of H pylori?

If the patient is taking PPIs

28

What does H pylori do?

Increases the pH of its microenvironment

29

What would H pylori look like in terms of histology?

Black dots in the crypt area of the stomach

30

How can we treat Peptic Ulcer Disease (PUD)

Antisecretory Therapy (PPI)
Test for presence of H pylori
Withdraw NSAIDs
Surgery

31

Is the peptide ulcer likely to be organic or functional if symptoms persist in the young?

Functional

32

What do we do if symptoms persist in a patient over 55

Refer for an endoscope

33

What are the 2 main groups of drugs used to treat ulcers? and give examples of both

H2RAs - Ranitidine or nizatidine
PPIs - Omeprazole or lansoprazole

34

Why is omerprazole better than H2RAs in Duodenal ulcers?

It heals duodenal ulcers faster

35

Why are H2RAs better than omeprazole in Duodenal Ulcers?

Therapy after four weeks is higher

36

What is the disadvantage of antacids such as Gaviscon ?

They take much longer and the patient is more likely to lose compliancy

37

What is the first line treatment of H Pylori

Triple therapy - 1 week of:
PPI + amoxycillin 1g bd + clarithromycin 500mg bd
PPI + metronidaxole 400mg bd + clarithromycin 250mg bd

38

What happens if the treatment of H pylori has not improved the symptoms

Biopsy may be required

39

What are the main side effects that occur during the treatment of H Pylori

Nausea, diarrhoea

40

Name 4 complications of peptic ulcer disease?

Anaemia
Bleeding
Perforation
Gastric outlet / duodenal obstruction

41

What follow up treatment is required for duodenal ulcers?

No follow up
Confirmation of helicobacter free
Rarely forms malignancy

42

What follow up treatment is required for Gastric Ulcers

Follow up endoscopy in 6-8 weeks
Ensure healing and no malignancy has formed which is common

43

What are some of the symptoms /risks of gastric cancer?

Dyspepsia and alarm symptoms such as weight loss, anaemia, mass, recurrent vomiting
Family history of gastric cancer
Achlorhydria (production of gastric acid in the stomach is absent or low, respectively)

44

What is the overall end result of H pylori infection regardless of the increase or decrease in acid

An increase in Gastrin

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