Flashcards in Peptic ulcer disease Deck (17)
1
What is dyspepsia
Non specific symptoms related to upper GI
May relate to food, bloating, umbilical discomfort
2
Alarm symptoms with dyspepsia
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms or hematemesis
Swallowing difficulty
3
Signs to elicit
Tender epigastrium
Abdominal mass
Supraclavicular nodes
4
Managing new dyspepsia
FBC
FOBT
>55 years or ALARM->Upper GI endoscopy
Stop drugs causing dyspepsia (NSAIDS, nitrates, anticholinergic, TCAs, CCB)
Lifestyle changes-> weight loss, smoking cessation, raise bed, small regular meals. Avoid hot drinks, spicy foods, alcohol, citrus, chocolate and eating test for H. pylori ->if +ve Eradication therapy and review in 4 weeks. If no improvement->UBT->if eradicated, do upper GI endoscopy
If initially -ve H pylori-> PPI for 4 weeks, if not improved will have longer dose and can consider upper GI endoscopy
5
What is more common gastric ulcers or duodenal ulcers
Duodenal
6
Major risk factors for duodenal ulcers
H pylori+++
NSAIDs, aspirin, steroids
Minor->+gastric acid, +gastric emptying, blood group O and smoking
7
Clinical presentation of duodenal ulcer
Epigastric pain before meals, at night
Relieved by eating or drinking milk
8
If doing an upper GI endoscopy, should PPIs be stopped
Yes, 2 weeks before
9
In what age group do gastric ulcers typically occur
Elderly
10
Risk factors for gastric ulcers
H pylori
Smoking
NSAIDs
Reflux of duodenal contents
Delayed gastric emptying
Stress-->neurosurgery = Cushing's ulcer, or burns->curling's ulcer
11
Symptoms of gastric ulcer
May be asymptomatic
Epigastric pain related to meals, relieved with antacids +/= weight loss
12
What is done at upper GI endoscopy
Visualise
Multiple biopsies
Cytology
13
How long is PPI treatment for GU compared to DU
GU->8 weeks
DU->4 weeks
14
Differential diagnosis of dyspepsia
Non-ulcer dyspepsia
OsophagitisGORD
DU/GU
Gastric malognancy
Duodenitis
Gastritis
15
Pathogenesis of GU related to NSAID use, intracranial, stress ulcers
NSAIDs-> -ve prostaglandins which normaly +mucin production and +vascular perfusion, therefore these are reduced
Intracranial->+activity of vagal nuclei= +gastric acid
Stress ulcers->splanchnic vasoconstriction
16
Complications of gastric ulcers
Perforation
Obstruction
Bleeding
17