FN: Peptic Ulcer Disease Flashcards Preview

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Flashcards in FN: Peptic Ulcer Disease Deck (26):
1

Classification

Acute or Chronic

2

Acute

Usually due to drugs (NSAIDS, steroids) or stress

3

Chronic

Drugs
H. Pylori
Raised Calcium
Zollinger Ellison

4

Two types

Duodenal Ulcers
Gastric Ulcers

5

Duodenal Ulcers path

4x commoner than GU
1st part of duodenum (Cap)
M>F

6

duodenal Ulcers RF

H. Pylori
Drugs: NSAIDS, steroids
Smoking
EtOH
Increased gastric emptying
Blood group O

7

Duodenal Ulcers presentation

Epigastric Pain:
Before meals and at night
Relieved by eating or milk

8

Gastric Ulcers path

Lesser curve of gastric antrum
Beware ulcers elsewhere (often malignant)

9

Gastric Ulcers Risk factors

H. pylori
Smoking
Drugs
Delayed gastric emptying
Stress:
1. Cushings: intracranial disease
2. Curling:L burns, sepsis, trauma

10

Gastric Ulcers presentation

Epigastric pain
1. Worse on eating
2. relieved by antacids

Wt. loss

11

Complications

Haemorrhage
Perforation
Gastric Outflow Obstruction
Malignancy

12

Haemorrhage

Haematemeis or melaena
Fe deficiency anaemia

13

Perforation

Peritonitis

14

Gastric Outflow Obstruction

Vomiting, colic, distension

15

Malignancy

Raised risk with H. pylori

16

Investigations

Bloods: FBc, urea (raised in haemorrhage)
C(13) breath test
OGD (stop PPIs >2 wks before)
Gastrin levels if Zollinger-ellison suspected

17

OGD process

CLO/urease test for H.pylori
Always take biopsies of ulcers to check for Ca

18

Management

Consverative
MEdical
surgical

19

Conservative

Lose wt.
Stop smoking and reduced EOH
Avoid hot dirnks and spicy food
Stop drugs: NSAIDS, steroids
OTC antacids

20

Medical

1. OTC antacids: Gaviscon, Mg trisilicate
2. H. pylori eradication
3. Full-dose acid suppression for 1-2 mo
-PPIs: lansoprazole 30mg OD
-H2RAs: ranitidine 200mg nocte
4. Low-dose acid suppressionPRN

21

Surgery for PUD Concepts

No acid -no ulcer
Secretion stimulated by gastrin and vagus N.

22

Vagotomy

Truncal: reduce acid secretion but prevents pyloric sphincter relaxtion therefore must by combined with pyloroplasty or gastroenterostomy

Selective: vagus nerve only denervated where it supplies lower oesophagus and stomach - nerves of laterjet (supply pylorus) left intact

23

Antrectomy with vagotomy

Distal half of stomach removed _ anastomosis:
1. directly to duodenum: billroth 1
2. To small bowel loop w/ duodenal stump oversenL billroth 2 or polyp

24

Subtotal gastrectomy with Roux-en-Y

Occasionally performed for Zollinger-Ellison

25

occasional physical

Stump eakage
Abdominal fullness
REflux or bilious vomiting (improves with time)
Stricture

26

Complications Metabolic

Dumping syndrome:
1. abdo distension, flushong, n.v
2. Early: osmotchypovolaemia
3. Late: reactive hypoglycaemia

Blind loop syndrome - malabsorption, diarrhoea
-Overgrowth of bacteria in duodenal stump
-Anaemia: Fe + B12
Osteoporosis

Wt. loss: malasborption of reduced calories intake

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