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A. Block C Paediatrics > Peptic ulcer disease and gastritis > Flashcards

Peptic ulcer disease and gastritis Flashcards

1
Q

What is a duodenal/gastric ulcer?

1 - thickening of mucosal membrane
2 - increased HCL production
3 - a break in the mucosal lining
4 - metaplasia of gastric to duodenal cells

A

3 - a break in the mucosal lining

  • caused by excessive HVL production or lack of mucus production
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2
Q

What is the incidence of gastric/duodenal ulcers in the developed world?

1 - 0.1%
2 - 1%
3 - 10%
4 - 30%

A

3 - 10%

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3
Q

Are gastric of duodenal ulcers more common?

A
  • duodenal ulcer
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4
Q

Are posterior of anterior duodenal ulcers more common?

A
  • anterior are more common
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5
Q

Which of the following is NOT a common symptom of gastric/duodenal ulcers?

1 - Epigastric pain
2 - Palpitations
3 - Bloating
4 - Satiety
5 - Haematemesis
6 - Malaena

A

2 - Palpitations

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6
Q

Which of these is NOT a typical presentation of a patient with a peptic ulcer?

1 - epigastric pain when eating
2 - bitter regurgitation/reflux
3 - epigastric pain hours after eating
4 - weight gain due to excessive food to relieve the pain

A
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7
Q

Which of these is NOT a typical presentation of a patient with a duodenal ulcer?

1 - epigastric pain when eating
2 - episodic waking in early hours
3 - epigastric pain hours after eating
4 - nausea/vomitting
5 - weight loss

A

3 - epigastric pain hours after eating

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8
Q

What is the most common site for a peptic ulcer in the stomach?

1 - fundus
2 - body
3 - antrum
4 - cardia

A

3 - antrum

  • particularly along the lesser curve
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9
Q

What is the most common site for a duodenal ulcer in the duodenum?

1 - 1st part
2 - 2nd part
3 - 3rd part
4 - 4th part

A

1 - 1st part

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10
Q

What is Zoillinger-Ellison syndrome?

1 - pancreatic tumour secreting lipase
2 - stomach tumour secreting HCL and pepsin
3 - gall bladder tumour secreting Ca2+
4 - stomach tumour secreting gastrin

A

2 - stomach tumour secreting HCL and pepsin

  • rare condition
  • causes widespread peptic ulceration
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11
Q

Although there are a number of causes of peptic/duodenal ulcers, what is the primary cause worldwide?

1 - NSAIDs
2 - smoking
3 - helicobacter pylori
4 - high BMI

A

3 - helicobacter pylori

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12
Q

The following are all methods for diagnosing helicobacter pylori, but which is the most sensitive?

1 - stool antigen test
2 - endoscopy with biopsy
3 - hydrogen breathe test
4 - serum anti-H.pylori immunoglobulin test

A

2 - endoscopy with biopsy

  • sample must be tested for urease production by the bacteria immediately and histology
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13
Q

One of the tests used to diagnose H. pylori is the CLO test. What is the purpose of this test?

1 - urease is measured in the blood
2 - level of urease is measured in a sample taken from the stomach
3 - the level of urease in a breath test can indicate the presence of H. pylori
4 - all of the above

A

2 - level of urease is measured in a sample taken from the stomach
- biopsy of stomach is tested

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14
Q

If a patient has been diagnosed with a peptic/duodenal ulcer, order the management plan:

  • surgery
  • lifestyle change
  • PPIs
  • H pylori medication
A

1st - lifestyle change
2nd - PPIs
3rd - H pylori medication
4th - surgery

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15
Q

If an ulcer is actively bleeding what treatment should they receive?

1 - PPI only
2 - endoscopically
3 - lifestyle intervention only
4 - H/ pylori antibiotics with PPI

A

2 - endoscopically
- this approach is diagnostic and therapeutic

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16
Q

Following an endoscopy to treat an actively bleeding ulcer, how soon will patients receive another oesophago-gastro-duodenoscopy (OGD)?

1 - 4 weeks
2 - 8 weeks
3 - 16 weeks
4 - 6 months

A

2 - 8 weeks
- important to ensure ulcer is healing properly

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17
Q

Helicobacteria Pylori is the most common cause of peptic ulcers worldwide. This is typically treated with 2 antibiotics and a PPI for 2 weeks. Which of the following is NOT typically 1st line treatment?

1 - Gentamicin
2 - Amoxicillin
3 - Lansoprazole
4 - Clarithroymocin

A

1 - Gentamicin

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18
Q

If a patient requires surgery for a gastric ulcer, what surgery would be performed?

1 - partial gastrectomy
2 - gastric bypass
3 - Roux-en-y bypass
4 - gastrectomy

A

1 - partial gastrectomy

  • where the ulcer is located
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19
Q

Which cell in the stomach secrete HCL?

1 - chief cells
2 - parietal cells
3 - G cells
4 - I cells

A

2 - parietal cells

  • chief cells secrete pepsinogen and gastric lipase
    G cells secrete gastrin
    I cells secrete CCK
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20
Q

When trying to distinguish between a gastric and duodenal ulcer we can link this with eating. Which ulcer hurts when eating and which hurts when not eating?

A
  • gastric = hurts with food and patients typically lose weight
  • duodenal = relieved with food so patients could gain weight
21
Q

How can duodenal or peptic ulcer cause haemorrhage?

1 - ulcers damage epithelium and cause bleeding
2 - ulcers cause perforation of organs and this causes bleeding
3 - ulcers perforate organ and then perforate the surrounding blood vessels

A

3 - ulcers perforate organ and then perforate the surrounding blood vessels

22
Q

Which of the following is NOT a common complication of gastric and duodenal ulcers?

1 - Haemorrhage
2 - Perforation
3 - Gallstones
4 - Gastric outlet obstruction
5 - Increased risk of gastric cancer (particularly with H. pylori infection)

A

3 - Gallstones

  • gastric outlet obstruction = narrowing of the pylorus
23
Q

If a patient has a duodenal or peptic ulcer that is caused by H.pylori it needs to be eradicated using a PPI (Omeprazole or Lansoprazole) with 2 antibiotics. Which antibiotics are typically given?

1 - clarithromycin and gentamicin or metronidazole
2 - clarithromycin and amoxicillin or metronidazole
3 - gentamicin and amoxicillin or metronidazole
4 - co-Amoxiclav and clarithromycin

A

2 - clarithromycin and amoxicillin or metronidazole

  • a 1 week dose normally eliminates the bacteria in 90% of patients
  • CLO test can be used to confirm eradication (yellow = negative and purple = positive)
24
Q

There are a number of causes that can cause an acute emergency presentation of peptic ulcer disease. Which of the following is NOT a common cause?

1 - distension
2 - perforation
3 - haemorrhage
4 - pyloric stenosis

A

1 - distension

25
Q

If a patient has a gastric perforation, where are the contents most likely to cause?

1 - peritonitis
2 - duodenumitis
3 - acute pancreatitis
4 - splenomegaly

A

1 - peritonitis

  • contents leak into peritoneal cavity
26
Q

If a patient presents with an emergency perforated peptic ulcer, what happens to the pain?

1 - starts and remains focused
2 - onset of epigastric pain that spreads across whole abdomen
3 - begins all over abdomen and then becomes focal

A

2 - onset of epigastric pain that spreads across whole abdomen

27
Q

If a patient presents with an emergency perforated peptic ulcer, how can this be diagnosed?

1 - examination, signs and erect X-ray
2 - examination and signs
3 - erect X-ray alone
4 - supine X-ray

A

1 - examination, signs and erect X-ray

  • may see gas under the diaphragm
28
Q

If a patient presents with an emergency perforated peptic ulcer, they can generally be diagnosed using examination, signs and erect X-ray. Why may a CT with a water soluble contrast be useful?

A
  • identify an perforation
  • DO NOT do gastroscopy as this requires the stomach to be inflated
29
Q

What can happen to the pyloric area of the stomach which is a common site for chronic ulceration?

1 - perforates
2 - stenosis with scar tissue and stricture can form
3 - haemorrhage

A

2 - stenosis with scar tissue and stricture can form

  • can progress to gastric outlet obstruction
30
Q

Patients with pyloric stenosis can present with a variety of symptoms. Which of the following are NOT common presentations?

1 - peptic ulcer pain (few weeks at most)
2 - episodic vomiting
3 - made better with eating
4 - unrelated to eating
5 - dehydrated

A

3 - made better with eating

  • may hear a succession splash
31
Q

What sites does upper GI bleeding NOT come from?

1 - oesophagus
2 - stomach
3 - duodenum
4 - gall bladder

A

4 - gall bladder

32
Q

What is the mortality rate of an upper GI bleed?

1 - 0.2-1%
2 - 2-10%
3 - 20-30%
4 - >50%

A

2 - 2-10%

33
Q

Which scoring tool can be used in upper GI bleeding?

1 - modified glasgow score
2 - Glasgow-Blatchford Bleeding Score
3 - CURB-65 score
4 - all of the above

A

2 - Glasgow-Blatchford Bleeding Score

34
Q

Which of the following is NOT an example of an oesophageal bleed?

1 - Oesophagitis
2 - Gastric varices
3 - Mallory Weiss tear
4 - Oesophageal varices
5 - Oesophageal ulcers
6 - Oesophageal cancer

A

2 - Gastric varices
- gastric bleed

35
Q

Which of the following is NOT an example of an gastric bleed?

1 - Gastric ulcer
2 - Mallory Weiss tear
3 - Gastric tumour (benign and malignant)
4 - Gastric varices
5 - Gastritis
6 - Dieulafoy lesions
7 - Portal hypertensive gastropathy
8 - Gastric antral vascular ectasia

A

2 - Mallory Weiss tear
- oesophageal bleed

36
Q

Which of the following is NOT an example of an duodenal bleed?

1 - Duodenal ulcer
2 - Vascular malformations
3 - Haemobilia (bleeding from the ampulla due to hepatobiliary pathology)
4 - Dieulafoy lesions

A

4 - Dieulafoy lesions
- vascular malformation that occurs in the stomach

37
Q

Upper GI bleeds can be separated into variceal and non-variceal bleeds. What are variceals?

1 - ruptured veins
2 - vein angiogenesis
3 - dilated veins that are susceptible to rupture
4 - blocked veins

A

3 - dilated veins that are susceptible to rupture

  • normally due to high blood pressure
  • non-variceal are by far the most common 89%
  • variceal accounts for only 11%
38
Q

If a patient has an upper GI bleed what colour will stool be that might be found in the stool?

1 - dark brown/black
2 - fresh red colour
3 - greeny red

A

1 - dark brown/black

  • called malena
39
Q

If a patient has an upper GI bleed they can present with a number of symptoms. Which of the following is NOT a common symptom?

1 - Tachycardia
2 - Hypotension
3 - Raised urea
4 - Hb drop
5 - Malaena
6 - Bradycardia
7 - Frank fresh PR bleed

A

6 - Bradycardia

40
Q

If a patient has an upper GI bleed what is the 1st line investigation?

1 - erect chest X-ray
2 - oesophagoGastroDuodenoscopy
3 - steroids
4 - CT with contrast

A

2 - oesophagoGastroDuodenoscopy

  • can diagnosis varices, gastritis, dieulafoy lesion, peptic Ulcer, tumour
41
Q

If a patient has an upper GI bleed what is the 1st and 2nd line treatment?

1 - erect chest X-ray
2 - steroids
3 - endoscopy
4 - CT with contrast

A

3 - endoscopy

42
Q

If a patient has an upper GI bleed the 1st and 2nd line treatment is performed using endoscopy. What is clipping?

1 - mechanical device that clips off excess tissue
2 - mechanical device that brings together 2 surfaces, closing the bleed
3 - mechanical device that embolises the damaged tissue

A

2 - mechanical device that brings together 2 surfaces, closing the bleed

43
Q

If a patient has an upper GI bleed the 1st and 2nd line treatment is performed using endoscopy. Why are adrenaline injections used?

1 - increase blood flow causing vasodilation
2 - decrease blood flow causing vasoconstriction
3 - decreases blood flow causing vasodilation

A

2 - decrease blood flow causing vasoconstriction

  • vasoconstriction and bleeding stops
44
Q

If a patient has an upper GI bleed the 1st and 2nd line treatment is performed using endoscopy. What is Sengstaken tube?

A
  • tube placed into area of bleed and balloon inflated
  • stops the bleed and allows clotting
45
Q

If a patient has an upper GI bleed the 1st and 2nd line treatment is performed using endoscopy. Patients can be given haemospray, what is this?

A
  • powdered spray placed on bleeds that promotes hemostasis
46
Q

If a patient has an upper GI bleed the 1st and 2nd line treatment is performed using endoscopy. Which blood vessel is susceptible to bleeding and may require radiological embolization?

1 - left gastric artery
2 - right gastric artery
3 - gastroduodenal artery
4 - left gastroepiploic artery

A

3 - gastroduodenal artery

47
Q

If a patient has an upper GI bleed the 1st and 2nd line treatment is performed using endoscopy. How many attempts using endoscopy need to be performed before surgery will be performed?

1 - 1
2 - 2
3 - 3
4 - 4

A

2 - 2

48
Q

If a patient has an upper GI bleed the 1st and 2nd line treatment is performed using endoscopy. If the damage to the duodenum is posterior, surgery will be laparotomy and going through the anterior aspect with a transverse incision. Sutures will be placed in the duodenum. What then needs to be done to the blood vessels to stop them bleeding?

1 - suture above, below and medial
2 - suture above only
3 - suture below only
4 - suture medially only

A

1 - suture above, below and medial

  • medial suture controls transverse pancreatic branch
49
Q

Following an endoscopy to treat an actively bleeding ulcer, how soon will patients receive another oesophago-gastro-duodenoscopy (OGD)?

1 - 4 weeks
2 - 8 weeks
3 - 16 weeks
4 - 6 months

A

2 - 8 weeks
- important to ensure ulcer is healing properly

A. Block C Paediatrics (50 decks)

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