Peptic Ulcer Disease Flashcards Preview

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Flashcards in Peptic Ulcer Disease Deck (28)
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1
Q

What is affected by peptic ulcer disease

A

Any acid affected site:
Oesophagus
Stomach
Duodenum

2
Q

What are the causes of PUD

A

High acid secretion

Loss of ability to defend against acid attacks

3
Q

Describe how high acid secretion causes PUD

A

Upregulation of gastrin produces acid secretion long after food stimulation is gone
The excess acid causes ulcers to develop

4
Q

Describe how normal levels of acid secretion can lead to PUD

A

There may be a reduced protective barrier to the stomach lining
The thin layer of mucus can be removed by drugs such as NSAIDS or steroids, but also by the bacteria Heliobacter pylori

5
Q

What is a peptic ulcer

A

A burn which burns deep into tissues which may eventually extend through to erode an artery or potentially can go straight through the viscous wall and into the peritoneum - a perforated ulcer

6
Q

Describe the trend between peptic ulcers and age

A

Incidence increases up to about age 50 then starts to fall again

7
Q

Describe how H.pylori can cause a peptic ulcer to form

A

Bacteria gets into the protective mucous, removes it and allows acid attack and inflammation to happen within the stomach lining

8
Q

What are the effects of H.pylori

A

Gastric ulcers

Chronic gastric wall inflammation - lymphoma of the stomach

9
Q

Why is chronic gastric wall inflammation considered a mucosa associated lymphoid tumour (MALT)

A

If you remove the cause, the lymphoma will disappear

10
Q

How is H.pylori eliminated

A

Triple therapy:
2 antibiotics - usually amoxicillin with metronidazole
1 proton pump inhibitor - usually omeprazole
Given for 2 weeks

11
Q

What are the signs and symptoms of PUD

A

Often none
Epigastric burning pain
Signs usually only present when complications are present such as bleeding or perforations

12
Q

Describe epigastric burning pain

A

Worse before or just after meals
Worse at night
Relieved by food, alkali and vomiting

13
Q

What investigations can be carried out for PUD

A

Endoscopy - allows visualisation of the tissues and a biopsy to be taken to check for H.pylori
Radiology - barium meal
Anaemia - FBC and FOB
H.pylori test - breath, antibodies and mucosa

14
Q

What systemic complications can be caused by PUD

A

Anaemia

15
Q

What local complications can be caused by PUD

A

Perforation
Haemorrhage
Stricture
Malignancy

16
Q

Describe the consequences of a haemorrhage caused by PUD

A

Erosion of the ulcer into a blood vessel will cause bleeding into the stomach leaving a large quantity of blood in the stomach which can be vomited up
It is often brown and granular - coffee ground vomit
If found it should always trigger an endoscopy quickly as there may be a significant vessel bleeding

17
Q

Describe the consequences of stricture caused by PUD

A

Stricture may form as the chronic irritation and ulceration heal by secondary intention
If this produces a scar which contracts it can reduce the size of the exit from the stomach

18
Q

What medical treatments can be carried out for PUD

A

Smoking cessation
Small regular meals
H.pylori eradication therapy
Ulcer healing drugs - proton pump inhibitors

19
Q

What surgical treatments can be carried out for PUD and why may they be carried out

A

Endoscopy - to decide whether a surgical or medical approach is most effective
Surgical excision - excision of the ulcer through a partial gastrectomy - now considered last resort
Vagotomy to reduce acid secretion by dividing the vagus nerve

20
Q

When should surgical treatment be carried out for PUD

A
Following an acute event:
Stricture
Acute bleed
Perforation
Malignancy
21
Q

What types of medication can be used to treat PUD

A

H2 receptor blockers and proton pump inhibitors to reduce acid secretion
Eliminate H.pylori and use prostaglandin inhibitors to improve the mucosal barrier

22
Q

What must happen after triple therapy

A

H.pylori must be tested through either endoscopy and biopsy or through breath testing

23
Q

What different surgeries are available for PUD

A

Bilroth 1
Bilroth 2
Vagotomy

24
Q

Describe Bilroth 1 surgery

A

Allowed excision of part of the stomach and then anastomoses of the duodenum to the remaining part of the stomach

25
Q

What is the problem with Bilroth 1 surgery

A

No sphincter from the stomach to the duodenum so food can flow freely

26
Q

Describe Bilroth 2 surgery

A

Same stomach excision as Bilroth 1 but instead the stomach empties further down into the duodenum which causes less problems

27
Q

What is the problem with Bilroth 2 surgery and how is it resolved

A

Bind loop can cause bacterial proliferation but the pancreatic and biliary secretions still flow into this and keep moving the contents down

28
Q

Describe a vagotomy

A

By dividing the branches from the main vagal trunk passing into the stomach wall, the acid secretion caused by the neurological trigger can be reduced