Peptic Ulcer Disease

Question 1

Are peptic or duodenal ulcers more common?

Answer 1

duodenal

Question 2

How does the stomach lining protect itself from high levels of acid?

Answer 2

Mucin and bicarbonate secretion

Question 3

List 2 risk factors for gastric ulcers

Answer 3

1. NSAIDs
2. H. Pylori
3. Smoking
4. Delayed gastric emptying

Question 4

List 2 risk factors for duodenal ulcers

Answer 4

1. H. Pylori (90%)
2. NSAIDS
3. Chronic steroid use
4. SSRIs

Question 5

Describe the H.Pylori bacteria

Answer 5

Gram-negative bacteria producing the urease enzyme

Question 6

How does PUD present?

Answer 6

1. Epigastric pain
2. Nausea and vomiting
3. Dyspepsia

Question 7

Describe when pain is felt in a duodenal vs gastric ulcer

Answer 7

Duodenal ulcers: epigastric pain when hungry, relieved by eating

Gastric ulcers: epigastric pain worsened by eating

Question 8

How is PUD diagnosed?

Answer 8

Endoscopy

• During this a rapid urease test (CLO test) is performed to check for H. pylori
• Biopsy is considered to exclude malignancy

Question 9

Management of H. Pylori-negative PUD?

Answer 9

4-8 weeks of full dose PPI treatment and lifestyle advise

Question 10

List 4 pieces of lifestyle advise to give a patient with PUD

Answer 10

1. Stop smoking
2. Cut down on alcohol
3. Avoid NSAIDs
4. Avoid spicy foods and coffee

Question 11

Management of H.pylori positive PUD?

Answer 11

Tripple therapy: A PPI + amoxicillin + clarithromycin

Question 12

How to treat H.Pylori if patient is penicillin resistant?

Answer 12

PPI + metronidazole + clarithromycin

Question 13

What must we do following treatment of a patient with a gastric ulcer?

Why?

Answer 13

Repeat endoscopy 6-8 weeks after the start of PPI treatment to ensure ulcer healing and rule out malignancy

Question 14

List 3 complications of PUD

Answer 14

1. Bleeding
2. Perforation resulting in an “acute abdomen” and peritonitis
3. Scarring and strictures which can lead to pyloric stenosis

Question 15

How would a patient present if they had perforation secondary to PUD.

Answer 15

Sudden onset epigastric pain, later becoming more generalised

Patients may describe syncope

Question 16

First line Investigation for a suspected perforation secondary to PUD

What will be seen?

Answer 16

An upright (‘erect’) chest x-ray

Will show free air under the diaphragm

Question 17

If a patient with PUD is bleeding, how will they present?

Answer 17

1. Haematemesis
2. “coffee ground” vomiting
3. Melaena
4. hypotension, tachycardia

Question 18

Which artery is most commonly affect in bleeding secondary to PUD?

Answer 18

gastroduodenal artery

Question 19

Management of a bleeding peptic ulcer

Answer 19

1. ABCDE
2. IV PPI
3. First-line treatment is endoscopic intervention