Peptic Ulcer Disease

Question 1

Peptic Ulcer Disease is an umbrella term and refers to which types of ulcers

Answer 1

Duodenal and gastric

Question 2

Which ulcer is the pain worsened by eating

Answer 2

Gastric ulcers

Question 3

Which ulcer is the pain improves by eating

Answer 3

Duodenal ulcers

Question 4

What is the main risk factor for peptic ulcer disease

Answer 4

Helicobacter pylori infection.

Question 5

Helicobacter pylori infection is the main risk factor for peptic ulcer disease.

Name other risk factors

Answer 5

NSAID use

smoking

foods and drink that increase acid production e.g. acidic foods, coffee, fatty or spicy foods

Question 6

What is the gold standard imaging investigation for peptic ulcer disease

Answer 6

Upper GI endoscopy

Question 7

Name the two gold standard investigations for peptic ulcer disease

Answer 7

Upper GI endoscopy

testing for H Pylori infection by urea breath test or stool antigen test

Question 8

What are the 3 classic features of peptic ulcer disease

Answer 8

dyspepsia - indigestion

abdominal discomfort

nausea

Question 9

What is an ulcer

Answer 9

a deep break through the full thickness of the epithelium or mucosal surface

Question 10

What are the most commonly identified aetiological factors of peptic ulcer disease

Answer 10

H. pylori infection and history of NSAID use

Question 11

Answer 11

Question 12

Which is the most common

a) Gastric ulcer
b) Duodenal ulcer

Answer 12

b) Duodenal ulcer

Question 13

Epigastric pain worsened by eating is a feature of :

a) Gastric ulcer
b) Duodenal ulcer

Answer 13

a) Gastric ulcer

Question 14

Epigastric pain relieved by eating is a feature of :

a) Gastric ulcer
b) Duodenal ulcer

Answer 14

b) Duodenal ulcer

Question 15

Epigastric pain wrosened when hungry is a feature of :

a) Gastric ulcer
b) Duodenal ulcer

Answer 15

b) Duodenal ulcer

Question 16

Weight loss is a feature of :

a) Gastric ulcer
b) Duodenal ulcer

Answer 16

a) Gastric ulcer

Question 17

Weight gain is a feature of :

a) Gastric ulcer
b) Duodenal ulcer

Answer 17

b) Duodenal ulcer

Question 18

Haematemesis is a feature of :

a) Gastric ulcer
b) Duodenal ulcer

Answer 18

a) Gastric ulcer

Question 19

Melaena and coffee ground vomitus is a feature of :

a) Gastric ulcer
b) Duodenal ulcer

Answer 19

b) Duodenal ulcer

Question 20

Which peptic ulcer disease is associated with an increased risk of carcinoma

a) Gastric ulcer
b) Duodenal ulcer

Answer 20

a) Gastric ulcer

Question 21

Which peptic ulcer disease is aggravated immediately after food

a) Gastric ulcer
b) Duodenal ulcer

Answer 21

a) Gastric ulcer

Question 22

Which peptic ulcer disease is aggravated when thte stomach is empty (1-2 hours after a meal)

a) Gastric ulcer
b) Duodenal ulcer

Answer 22

b) Duodenal ulcer

Question 23

What aggrevates duodenal ulcers

Answer 23

When the stomach is empty (1-2 hours after a meal)

Question 24

Which peptic ulcer disease is alleviated by vomiting or alkali food

a) Gastric ulcer
b) Duodenal ulcer

Answer 24

a) Gastric ulcer

Question 25

Which peptic ulcer disease is alleviated by food intake a) Gastric ulcer b) Duodenal ulcer

Answer 25

b) Duodenal ulcer

Question 26

What two mechanism make the gastric mucosa prone to ulceration

Answer 26

- Breakdown of the protective layer of the stomach and duodenum - Increase in stomach acid

Question 27

Breakdown of the protective barrier of the stomach and duodenum can cause peptic ulcer disease. What two factors can breakdown the protective barrier

Answer 27

o Medications e.g. steroids or NSAIDs o Helicobacter pylori (H.Pylori)

Question 28

Increase in stomach acid can cause peptic ulcer disease. Name some of the causes of the increase in stomach acid

Answer 28

Stress Alcohol Caffeine Smoking Spicy foods

Question 29

What is the main risk factor of peptic ulcer disease

Answer 29

Helicobacter pylori infection

Question 30

What is the second most common risk factor of peptic ulcer disease

Answer 30

NSAID use

Question 31

Name some of the risk factors of peptic ulcer disease

Answer 31

* Helicobacter pylori infection - most common cause * NSAID use - 2nd most common cause * Other medications e.g. SSRIs, chronic steroid use, bisphosphonates * Smoking * Severe stress * Zollinger-Ellison syndrome: rare cause characterised by excessive levels of gastrin, usually from a gastrin secreting tumour * Gastric emptying

Question 32

Increase in gastric emptying is a risk factor for which type of peptic ulcer disease

Answer 32

Duodenal ulcers Increased gastric emptying for duodenal ulcers as there is more acid in the duodenum

Question 33

Delayed in gastric emptying is a risk factor for which type of peptic ulcer disease

Answer 33

Gastric ulcers Delayed gastric emptying for gastric ulcers as there is an increase length of time the stomach is exposed to the acid

Question 34

What is the gold standard investigation for peptic ulcer disease

Answer 34

Upper GI endoscopy

Question 35

What test can be performed during endoscopy for investigating peptic ulcer disease

Answer 35

A rapid urease test can be performed to check for H. pylori

Question 36

What three investigations can be done to test for H.Pylori infection, as part of the workup of peptic ulcer disease

Answer 36

* Rapid urease test - done only using endoscopy * Urea breath test * Stool antigen test

Question 37

Eradication therapy should be commenced in patients that are Helicobacter pylori positive. Describe the eradication therapy for H pyolori

Answer 37

Eradication therapy is a triple-therapy that comprises: PPI and 2 antibiotics Typically a 7-day course of oral PPI plus amoxicillin and either clarithromycin or metronidazole If penicillin allergic, oral PPI plus clarithromycin and metronidazole

Question 38

What is the management of peptic ulcer disease that are H.Pylori negative

Answer 38

4-8 weeks of full dose PPI treatment and lifestyle advice, including: * Have more regular, smaller meals and eat 4 hours before bed * Smoking cessation * Avoid foods and drinks that increase stomach acid e.g. acidic foods, coffee, fatty or spicy foods * Weight loss * Stop causative medications e.g. NSAIDs, steroids, bisphosphonates, potassium supplements, SSRIs and crack cocaine

Question 39

By what mechanism are NSAIDs responsible for causing gastric ulceration?

Answer 39

Inhibition of prostagladin secretion

Question 40

Zollinger-Ellison syndrome is most commonly associated with which condition?

Answer 40

Multiple Endocrine Neoplasia syndrome