Peptic Ulcer Disease

Question 1

What is peptic ulcer disease?

Answer 1

• ulcers (formation of open sores) in mucous membrane of stomach (gastric ulcer)/duodenum(duodenal ulcer)

Question 2

What is an ulcer?

Answer 2

• erosion/break in mucous lining
• expose underlying tissue to stomach acid and digestive enzymes

Question 3

What causes the ulcers?

Answer 3

• disturbance in equilibrium between substances that promote gastric and duodenal damage and those that provide protection
• aggressive factors: H.pylori infection ,NSAIDS use, increased stomach acid secretion
  -protective factors: physiological mechanism of mucus production, repair and regeneration of mucosal lining

Question 4

What is the pathophysiology of the disease?

Answer 4

• H.pylori infection: bacteria weaken mucosal barrier= trigger inflammation, mucosa more open to damage from gastric acid
• Excessive gastric acid = overproduction of stomach acid–damage mucosal lining directly = ulcer forms
• NSAID use = irritate stomach lining, reduce protective mucus productions = increase risk of ulcers
• rare cause = Zollinger Ellison syndrome: (due to gastrinoma)–neuroendocrine tumour in pancreas/duodenal wall, secrete abnormal amount of gastrin, stimulate parietal cells = release excess HCL, overwhelm defence mechanisms=ulcers develop in duodenum/distal duodenum/jejunum

Question 5

What are the risk factors?

Answer 5

• H.pylori infection
• usage of NSAIDS a lot
• smoking: impair healing of ulcers=increase likelihood of recurrence
• excessive alcohol use = irritate stomach lining = ulcer likely
• stress

Question 6

What are the complications?

Answer 6

• deep ulcers = bleeding = develop around blood vessels, dangerous if near artery = lead to haemorrhage into GI tract = rapid loss of blood = shock
• dangerous spots = gastric ulcer in less curved part of stomach = erode near left gastric artery
• dangerous spot = duodenal ulcer near gastroduodenal artery
  -perforation = well known complication for duodenal ulcers on anterior wall, ulcer erodes all the way through wall of duodenum/stomach, GI contents get into peritonitis space (usually sterile), air collect under diaphragm = impair phrenic nerve = pain up to shoulder

Question 7

Signs/symptoms?

Answer 7

• nausea/vomiting
• epigastric pain
• bloating,belching,
• gastric ulcer pain = hard to eat, pain felt instantly, pain worse during daytime = weight loss
• duodenal ulcer pain = okay to eat food but pain is 2/3hours after meal, pain worsens at night = weight gain

Question 8

Diagnosis

Answer 8

• upper endoscopy = tube goes into stomach and duodenum to find ulcers and biopsy for H pylori testing
• H ployri tests = blood/stool/breath tests
• imaging

Question 9

Management

Answer 9

• H pylori infection: combo of antibiotics and acid lowering meds = PPI, amoxicillin, clarithomycin twice for 7 days
• lifestyle changes (decrease smoking, alcohol, caffeine, NSAIDS use)
• extreme cases: surgery