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Flashcards in Gastro - Online MedEd - peptic ulcer Deck (19):

PUD - what is it?

Ulcers of stomach and duodenum
-Gastric ulcers - H. pylori (usually)
-Duodenum - H. pylori (always)


5 aetiologies of PUD

1. H. pylori
3. Malignancy
4. Curling ulcers
5. Cushing ulcers
6. Gastrinoma (ZE syndrome)


Presentation of PUD

1. Asymptomatic (20%)
2. Gnawing epigastric pain - someway related to food
-Worse with eat = gastric ulcer
-Better with eat, pain hours later = duodenal ulcer (acid leave stomach to duodenum)
-History is insufficient to determine location of ulcer


Diagnosis of PUD

Endoscopy and biopsy
-Rule out malignancy
-Rule out H. pylori
-Look at ulcer and kind of know what type:
NSAIDs - shallow and multiple
Malignancy - big, heaped up margins, necrotic centre
-H. pylori - single ulcer


Curling ulcer

Think of curling iron --> occur in burn patients


Cushing ulcer

Occur with increased intracranial pressure, also on steroids and ventilators
-With these people, want to feed as early as possible (NG tube trickle feed) and use GUT prophylaxis/PPI = develop ulcers in hospital



Refractory ulcer, usually multiple


Treat all ulcers what to do?

Stop smoking and drinking - impair healing
Stop NSAIDs - actually a cause of ulcers
PPI - ulcers better and symptomatic better
-Sometimes need to restart NSAID/i.e. aspirin --> so start with high dose PPI to treat ulcer, then continue on low dose PPI as prophylaxis
-PPI better than H2 blockers


What are the complications of PUD?

Gastric outlet obstruction


EGD and biopsy main purpose is

Dx and rule out cancer


H. pylori treatment

Triple therapy
-Amoxicillin/Metronidazole if penicillin allergic


Malignancy ulcer disease treat

Stage and treat


H. pylori - what is it?

Infectious organism AND carcinogen
Most of the world is infected 50% exposed
85% asymptomatic
Small number will present with dyspepsia, PUD, small number with cancer/maltoma
*So need to treat H. pylori because can develop into cancer


Diagnosis of H. pylori
When to do each test and when useful

Each test has a particular use:
1. Serology - test and treat method, if positive serology, then treat (but could be previous infection), in order to treat, patient should not have been treated in past + have symptoms (after treatment, serology not useful)
2. Urea breath - initial diagnosis
3. Stool Ag - for after treatment/eradication
4. EGD Bx - the best; 1. Rapid urease test/change colour, 2. Culture, long time to come back, 3. Histology, see organism under microscopy **Best is histology


Zollinger Ellison - pathology

Cells at tend of stomach release gastrin --> stimulate parietal cells to make acid in stomach
-Gastrinoma - gastrin producing tumour (i.e. in pancreas) - makes gastrin regardless of how much acid in stomach (exogenous source of gastrin)
-Lots of acid = lots of ulcers
-Decrease in gastric pH (inappropriate)


Zollinger ellison ulcers

Big, virulent, refractory ulcers


ZE syndrome - history

Might have diarrhea, PUD symptoms
Prior PPI, not better


ZE syndrome - persistent symptoms - how to diagnose?

Gastrin level - really high: >1600 is gastrinoma
If gastrin level is moderate --> do secretin stimulation test (gastrin levels increase)
Next have to find gastrinoma --> use the somatostatin receptor syntography - look for gastrinoma wherever or CT scan


Treatment of ZE syndrome

If not, ZE tumour is benign --> but continuous secretion of gastrin --> cause gastric cancer