Peptic Ulcer Disease Flashcards
What does ‘peptic ulcer’ mean?
The term ‘peptic ulcer’ refers to ulcer found in the lower oesophagus, stomach and duodenum
Rarely, they can occur in the jejunum and ileum (usually after surgery).
ulceration of the mucosa of the stomach or proximal duodenum that penetrates to the muscularis mucosa
What pathogen are they caused by?
They are caused by infection with Helicobacter Pylori. It is thought that H. Pylori is transmitted through close social contact with an infected individual, and infections are associated with poor levels of sanitation.
80-90% of duodenal ulcers (DU) and 70% of gastric ulcers are attributed to H. pylori.
What is the name given to the inner lining of the GI tract?
Mucosa
How does the mucosa protect itself from stomach content?
it secretes mucus that contains bicarbonate that coats the surface and forms a barrier against stomach acid and digestive enzymes
Which are more common, gastric or duodenal ulcers?
duodenal ulcers
Give 5 risk factors for peptic ulcer disease that increase production of stomach acid:
1) stress
2) alcohol
3) caffeine
4) smoking
5) spicy food
Give 2 risk factors for peptic ulcer disease that disrupt the mucus barrier:
1) H. pylori infection
2) NSAID use
Give 3 clinical presentations associated with peptic ulcer disease:
1) epigastric discomfort or burning pain (often very localised)
2) nausea and vomitng
3) dyspepsia (indigestion)
When is the pain the worst for duodenal ulcer?
When you are hungry
When is the pain worse in gastric ulcers?
When you eat
Ulcers can bleed - give 4 symptoms of an upper GI bleed:
1) haematemesis (vomiting blood)
2) coffee ground vomiting
3) melaena (black, tarry stools)
4) fall in haemoglobin on full blood count
Give 5 drugs that increase the risk of bleeding from a peptic ulcer:
1) NSAIDs
2) aspirin
3) anticoagulants
4) steroids
5) SSRI antidepressants
Describe how to distinguish between gastric and duodenal ulcers based on history alone: (2)
1) eating typically worsens the pain of gastric ulcers so patients tend to lose weight due to the fear of pain on eating
2) the pain of duodenal ulcers tends to improve immediately after eating, followed by pain 2-3 hours later, meaning weight is stable or even increases
What are 3 non-invasive tests for peptic ulcer disease?
- Urea breath Test (for presence of H.Pylori)
- Serological tests for IgG
- Stool test
What invasive investigations are used in peptic ulcer disease?
Endoscopy. (OGD) This will confirm the presence of an ulcer by sight, but a sample of gastric mucosa may also be taken. This can be tested in three ways:
Put in a urea solution containing Phenol red. If H. Pylori is present, then the urea will be rapidly split to release ammonia, and the solution will increase in pH and change colour. This is known as the rapid urease test.
Cultured and tests against various antibiotics
Looked at histologically.
FBC – to check for anaemia
U+E – rarely shows up Zollinger-Ellison syndrome
Faecal occult blood
Barium meal test – sometimes used in patients who are unable to tolerate endoscopy.
