Peptic Ulcer Disease

Question 1

What is a peptic ulcer

Answer 1

A breaking in the lining of the GI tract extending through the muscular layer ( muscularis mucosae )

Question 2

In which location are peptic ulcers most common

Answer 2

Lesser curvature of the stomach

D1

Question 3

Give 2 defensive mechanisms of the GI mucosa

Answer 3

Surface mucus secretion

HCO3- ion release

Question 4

What are the two most common causes of peptic ulcer

Answer 4

H-pylori

NSAIDs

Question 5

Which ulcers are most common

Answer 5

Duodenal ulcers - 90%

Gastric ulcers - 10%

Question 6

How does H-pylori survive the acidic pH of the stomach

Answer 6

Produces a alkaline micro-environment

Question 7

How does H-pylori lead to peptic ulcers

Answer 7

Induces a inflammatory response and causes increased acid secretion bu inducing histamine release which acts on the parietal cells.

It also decreases HCO3- production

Question 8

How can NSAIDs cause peptic ulcer peptic ulcer formation

Answer 8

Decreased prostaglandin synthesis => vasoconstriction => less blood flow to stomach => less growth

Question 9

What is the gram stain of H-pylori

Answer 9

Gram -ve helix

Question 10

what are the risk factors of Peptic ulcers

Answer 10

H-pylori infections

Prolonged NSAID use

Zollinger-Ellison syndrome

Gastric bypass surgery

Physiological stress

Question 11

What are the clinical features of peptic ulcer disease

Answer 11

1. Epigastric pain/retrosternal pain
2. Nausea
3. Bloating

May present with PUD complications:

• haematemesis
• perf

Question 12

What are the differential diagnosis

Answer 12

Things that cause epigastric pain

Dyspepsia

Chest pain

Question 13

What is the characteristic finding of someone with ZES

Answer 13

Fasting gastrin of above 1000pg/ml

Question 14

what is the triad of ZES

Answer 14

Severe PUD

Gastric acid hyper secretion

Gastrinoma

Question 15

How would you investigate PUD

Answer 15

Carbon 13 urea breath test

Serum antibodies to H pylori

Stool antigen test

Question 16

What tests would you want to do in older patients/red flag symptoms/ongoing treatment

Answer 16

OGD, can do a biopsy from around ulceration site to rule out malignancy

Question 17

What needs to be done prior to H-pylori testing

Answer 17

Stop any treatments 2 weeks prior as we do not want any false negatives

Question 18

what are the conservative treatments for PUD

Answer 18

Lifestyle advice:
- smoking cessation

• weight loss
• reduce alcohol

Question 19

What is the medical treatment for pUD

Answer 19

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

Question 20

What is the surgical management of PUD

Answer 20

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

Question 21

what are the complications of PUD

Answer 21

Perforation

Haemorrhage

Pyloric stenosis