Peptic ulcer disease Flashcards Preview

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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

How does obstruction occur in gastric ulcers

Most commonly in chronic
Edema and scarring
Puloric channel ulcers

May present as incapacitating crampy abdominal pain, rarely total obstruction/intractable vomiting