Peptic Ulcer Disease Flashcards Preview

Gastrointestinal Conditions > Peptic Ulcer Disease > Flashcards

Flashcards in Peptic Ulcer Disease Deck (27):
1

What are peptic ulcers?

Ulceration within the stomach or duodenum

2

Which type of peptic ulcer is more common?

DU = 4x more common than GU

3

In which population do gastric ulcers mainly occur?

Elderly

4

Causes of peptic ulcers:

* H. pylori infection
* Drugs
NSAIDs
Steroids
SSRIs
* Smoking (GU mainly)

5

H. pylori is associated with what percentage of peptic ulcers?

90% DUs
80% GUs

6

What percentage of those >50 are infected with H. pylori?

50%

7

Infection with H. pylori results in what?

Antral gastritis

Leading in some to peptic ulceration

Leading in some to gastric cancer

8

Which blood group is associated with each type of peptic ulcer?

DU: O

GU: A

9

General risk factors for peptic ulcer disease:

* Alcohol abuse
* CKD
* NSAIDs
* Advancing age
* Low SES

10

Risk factors for GU:

* H. pylori (80% cases)
* Smoking
* NSAIDs
* Reflux of duodenal contents
* Delayed gastric emptying
* Severe physiological stress (Cushings/Curlings)

11

What are Curling's and Cushing's ulcers?

Gastric ulcers induced by severe physiological stress

Curling's: Severe burns
Cushing's: Raised ICP

12

Risk factors for DU:

* H. pylori (90% cases)
* NSAIDs
* Steroids
* SSRIs
* Increased gastric acid secretion
* Rapid gastric emptying
* Smoking
* Blood group O

13

Symptoms of peptic ulcer disease:

* Epigastric pain
Worsened by eating in GU
Improved by eating in DU
* Nausea
* Fullness after meals
* Bloating
* Oral flatulence
* Heartburn
* Pain radiating to back
Posterior ulcer

14

Red flag features of peptic ulcers:

Anaemia
Loss of weight
Anorexia
Recent onset/progressive
Melaena/haematemesis
Swallowing difficulty

15

Signs in peptic ulcer disease

Epigastric tenderness

Succussion splash

16

Differential diagnosis

* GORD
* Oesophagitis
* Non-ulcer dyspepsia
* Gastric malignancy
* Gallstones
* Gastritis/duodenitis
* Crohn's disease
* Zollinger-Ellison syndrome
* IBS
* Chronic pancreatitis
* Pancreatic Ca
* AAA
* Hepatitis

17

Methods of H. pylori testing:

1. Carbon-13 urea breath test

2. Stool antigen test

18

When is endoscopy required in peptic ulcer disease:

If +55

OR

If any ALARM Sx

19

Investigations for peptic ulcer disease:

1. FBC ?IDA

2. H. pylori testing

3. Endoscopy

20

Lifestyle management of peptic ulcer:

* Smoking cessation
* Reduce alcohol
* Review medications

21

H. pylori eradication therapy:

PPI + 2x ABX

e.g. Lansoprazole 30mg BD, Clarithromycin 250mg BD + Amoxicillin 1g BD

22

Management plan for peptic ulcers:

1. Lifestyle

2. Test for H. pyloti

3. Positive
Eradication therapy

4. Negative
PPI alone

23

How long should PPIs be continued for in peptic ulcer disease?

4 weeks DU

8 weeks GU

24

Indications for surgical management of peptic ulceration:

Emergencies

Perforation/haemorrhage

25

Complications of peptic ulceration:

Haemorrhage

Perforation

Malignancy

Gastric outflow obstruction

26

Patient's on which medication may present later and with fewer defining symptoms of peptic ulcer perforation?

Steroids

27

Complications of acid suppression:

RARE

* Liver dysfunction
* Hypersensitivity reactions
* Depression
* Interstitial nephritis
* Blood disorders
* Skin reactions