Peptic Ulcer Disease Flashcards
(21 cards)
What is a peptic ulcer
A breaking in the lining of the GI tract extending through the muscular layer ( muscularis mucosae )
In which location are peptic ulcers most common
Lesser curvature of the stomach
D1
Give 2 defensive mechanisms of the GI mucosa
Surface mucus secretion
HCO3- ion release
What are the two most common causes of peptic ulcer
H-pylori
NSAIDs
Which ulcers are most common
Duodenal ulcers - 90%
Gastric ulcers - 10%
How does H-pylori survive the acidic pH of the stomach
Produces a alkaline micro-environment
How does H-pylori lead to peptic ulcers
Induces a inflammatory response and causes increased acid secretion bu inducing histamine release which acts on the parietal cells.
It also decreases HCO3- production
How can NSAIDs cause peptic ulcer peptic ulcer formation
Decreased prostaglandin synthesis => vasoconstriction => less blood flow to stomach => less growth
What is the gram stain of H-pylori
Gram -ve helix
what are the risk factors of Peptic ulcers
H-pylori infections
Prolonged NSAID use
Zollinger-Ellison syndrome
Gastric bypass surgery
Physiological stress
What are the clinical features of peptic ulcer disease
- Epigastric pain/retrosternal pain
- Nausea
- Bloating
May present with PUD complications:
- haematemesis
- perf
What are the differential diagnosis
Things that cause epigastric pain
Dyspepsia
Chest pain
What is the characteristic finding of someone with ZES
Fasting gastrin of above 1000pg/ml
what is the triad of ZES
Severe PUD
Gastric acid hyper secretion
Gastrinoma
How would you investigate PUD
Carbon 13 urea breath test
Serum antibodies to H pylori
Stool antigen test
What tests would you want to do in older patients/red flag symptoms/ongoing treatment
OGD, can do a biopsy from around ulceration site to rule out malignancy
What needs to be done prior to H-pylori testing
Stop any treatments 2 weeks prior as we do not want any false negatives
what are the conservative treatments for PUD
Lifestyle advice:
- smoking cessation
- weight loss
- reduce alcohol
What is the medical treatment for pUD
Patients negative for H-pylori but have confirmed ulceration from OGD =>. PPI for 4-8 weeks to reduce acid production then reassess
Patients postive for H-pylori
=> eradication therapy: Amoxilln ( metro ) + PPI + clarithromycin
What is the surgical management of PUD
Only done if the cause of PUD is a tumor eg ZES.
Or if there has a been a perf => omental patch
In relapsing disease they may do partial gastrectomy/ selective vagotomy
what are the complications of PUD
Perforation
Haemorrhage
Pyloric stenosis
