Peptic ulcer disease and gastritis

Question 1

Types of ulcers

Answer 1

Gastric ulcer

Duodenal ulcer (more common)

Question 2

Pathophysiology

Answer 2

Stomach mucosa prone to ulceration from breakdown of protective layer of stomach and duodenum and increase in stomach acid

Protective layer can be broken down by medications (steroids/ SSRIs/ NSAIDs/ bisphosphonates) and H.pylori

Increased acid from stress, alcohol, caffeine, smoking, spicy foods

Question 3

Presentation

Answer 3

Epigastric discomfort or pain

Nausea and vomiting

Dyspepsia

Bleeding- haematemesis, coffee ground vomit, melaena

Iron deficiency anaemia

Question 4

Diagnosis

Answer 4

Endoscopy

Rapid urease test (CLO test) for H.pylori

Biopsy to exclude malignancy

Question 5

Medical treatment

Answer 5

High dose PPI

Question 6

Complications

Answer 6

Bleeding

Perforation

Scarring and strictures

Question 7

Acute bleeding

Answer 7

Gastroduodenal artery can be source of significant GI bleed

Causes haematemesis, melaena, hypotension and tachycardia

Question 8

Acute bleeding management

Answer 8

A-E approach

IV PPI

Endoscopic intervention first line

If this fails then interventional angiography with transarterial embolisation or surgery

Question 9

Perforation presentaiton

Answer 9

Epigastric pain- later more generalised

May have syncope

Acute onset of symptoms

Question 10

Perforation investigations

Answer 10

Largely clinical diagnosis

Upright chest xray- free air under diaphragm

Question 11

Zollinger-Ellison syndrome

Answer 11

Excessive levels of gastrin

Usually from a gastrin secreting tumour