Gastric / duodenal ulcer disease Flashcards
(30 cards)
Describe the forces of attack against the stomach?
- Acid
- Pepsin
- Helicobacter pylori
Describe the forces of defence of the stomach?
- Cell turnover
- Mucus secretion
- Mucosal blood flow
- Bicarbonate secretion
Describe the symptoms of dyspepsia and peptic ulcer disease?
- Epigastric pain related to:
- Hunger
- Specific foods
- Time of the day
- Heartburn (retrosternal pain)
- ALARM symptoms
- Anaemia (IDA), Loss of weight, Anorexia, Recent onset, Melaena, Swallowing difficulty
Describe some tests for H. pylori?
- Invasive
- CLO test (campylobacter-like organism)
- Histology
- Culture
- Non-invasive
- Urea breath test (most accurate non-invasive test)
- Stool antigen
- Serology
Describe the management of someone with dyspepsia/peptic ulcer disease who tests positive for H. pylori?
- PPI + 2 antibiotic combination
- eg Lansoprazole, clarithromycin, amoxicillin
- If negative for H. pylori: give acid suppression alone
Risk factors for a duodenal ulcer?
- Major:
- H. pylori
- Drugs: NSAIDs, steroids, SSRI
- Minor:
- Increased gastric acid secretion
- Blood group O
- Smoking
Symptoms of duodenal ulcer?
- Asymptomatic
- Epigastric pain (relieved by antacids)
- +/- weight loss
Signs of duodenal ulcer?
Epigastric tenderness
Describe the diagnosis of a duodenal ulcer?
- Upper GI endoscopy
- Test for H. pylori
- If Zollinger-Ellison is suspected:
- Test gastrin secretions when not taking PPIs
Differentials for a duodenal ulcer?
- Duodenal Crohn’s
- TB
- Lymphoma
- Pancreatic cancer
Treatment for Duodenal ulcer?
- PPI eg Lansoprazole
Describe Gastric ulcers?
- Mainly in the elderly
- Risk factors: H. pylori, smoking, NSAIDs, reflux
- Symptoms: Asymptomatic/epigastric pain +/- weight loss
Tests for Gastric ulcers?
- Upper GI endoscopy (exclude malignancy)
- Multiple biopsies from ulcer rim and base
- Histology
- H. pylori tests
- Upper GI endoscopy after 8 weeks
- (exclude malignancy and confirm healing)
Risk factors for Gastritis?
- Alcohol
- NSAIDs
- H. pylori
- Reflux/hiatus hernia
- Granulomas (Crohns, sarcoidosis)
- Zollinger-Ellison syndrome
Symptoms of Gastritis?
- Epigastric pain
- Vomiting
Descrbie the treatment for dyspepsia and peptic ulcer disease?
- Lifestyle
- Reduce alcohol and tobacco
- H. pylori eradication (triple therapy)
- Drugs to reduce acid
- PPIs (lansoprazole
- H2 blockers (ranitidine)
- Drug-induced ulcers
- Stop drugs + PPI
- Surgery
Complications of dyspepsia and peptic ulcer disease?
- Bleeding
- Perforation
- Malignancy
- Reduced gastric outflow
Describe Functional (non-ulcer) dyspepsia?
- H. pylori eradiation if positive result may help
- PPIs
- Psychotherapy
- Amitriptyline
Describe the management pathway for dyspepsia?
Describe Zollinger-Ellison syndrome?
- Peptic ulcers with gastrin secreting adenoma (gastrinoma)
- Adenoma usually in the pancreas
- Associated with MEN1
Symptoms of Zollinger-Ellison syndrome?
- Abdominal pain
- Dyspepsia
- Chronic diarrhoea (inactivation of pancreatic enzymes => steatorrhoea)
Tests for Zollinger-Ellison syndrome?
- Fasting serum gastrin level
- Measure on 3 different days
- Localize/stage the adenoma:
- Somatostatin receptor scintigraphy
- Endoscopic US
- CT
Treatment for Zollinger-Ellison syndrome?
- High-dose PPIs (omeprazole)
- Dose based on intra-gastric pH
- If well differentiated:
- Somatostatin analogues
- Chemotherapy can also be used
What is pictured here?
- OctreoScan
- Patient has metastatic MEN1 gastrinoma
- Thin arrow: Solitary hepatic metastatic deposit
- Thick arrow: Gastric neuroendocrine tumour
