Peptic ulcer disease

Question 1

What is the most common kind of peptic ulcer?

Answer 1

Duodenal ulcers

Question 2

What causes the mucosa to ulcerate in PUD?

Answer 2

Breakdown of the protective layer of mucus secreted by mucosa:

• Medications e.g. NSAIDs, steroids
• H.Pylori

Increased acid:

• Stress
• Alcohol
• Caffeine
• Smoking
• Spicy food

Question 3

Presentation of peptic ulcer disease

Answer 3

Epigastric discomfort or pain
Nausea and vomiting
Dyspepsia
Bleeding causing haematemesis, “coffee ground” vomiting and melaena
Iron deficiency anaemia (due to constant bleeding)

Question 4

Differentiating between duodenal and gastric ulcers by symptoms

Answer 4

Eating typically worsens pain in gastric ulcers

Eating typically improves the pain of duodenal ulcers

Question 5

Investigations and management of peptic ulcers

Answer 5

Test for H. Pylori - either urea breath test or stool antigen test

Treatment with high dose PPIs (same as GORD) - plus antibiotics if H. Pylori positive

Peptic ulcers are diagnosed by endoscopy - can do CLO test here for H. Pylori
- Consider biopsy to exclude malignancy (can look similar to ulcer)

Question 6

Potential complications of peptic ulcer disease

Answer 6

UGIB from bleeding ulcer

Perforation - resulting in acute abdomen and peritonitis
- Requires urgent surgical repair

Scarring and strictures of muscle/mucosa
- Can lead to pyloric stenosis (presents with upper abdominal pain, distention, nausea and vomiting, particularly after eating)