Peptic ulceration

Question 1

symptoms dyspepsia/PUD

Answer 1

epigastric pain related to hunger, specific foods or time of day; bloating; fullness after meals; heartburn; tender epigastrium

Question 2

what are the ALARM symptoms in dyspepsia/PUD

Answer 2

Anaemia, Loss of weight, Anorexia, Recent onset, Malaena/haematemesis; swallowing difficulty

Question 3

when would you test for H pylori

Answer 3

someone <55 years

Question 4

when would you refer to endoscopy

Answer 4

> 55 and new dyspepsia, alarm symptoms

Question 5

which type of ulcer is most common

Answer 5

duodenal ulcer (4x more common than gastric ulcer)

Question 6

risk factors for duodenal ulcer (major)

Answer 6

H pylori, drugs

Question 7

which drugs are a risk in ulcer

Answer 7

NSAIDS, steroids, SSRI

Question 8

minor factors for DU

Answer 8

incr gastric acid secretion, increase gastric emptying (decr pH), blood group O, smoking

Question 9

symptoms DU

Answer 9

epigastric pain before meals or at night, relieved by eating or drinking milk

Question 10

signs DU

Answer 10

epigastric tenderness

Question 11

diagnosis DU

Answer 11

upper GI endoscopy. test for H pylori. measure gastrin conc when off PPIs (Zollinger Ellison syndrome suspected).

Question 12

differential diagnosis DU

Answer 12

non ulcer dyspepsia, duodenal Crohns, TB, lymphoma, pancreatic cancer

Question 13

Risk factors of gastric ulcer

Answer 13

H pylori (80%), smoking, NSAIDS, reflux duodenal contents, delayed gastric emptying, stress

Question 14

symptoms GU

Answer 14

asymptomatic or epigastric pain- related to meals and relieved by antacids. plus weight decr

Question 15

tests GU

Answer 15

upper endoscopy to exclude malignancy, biopsies, brushings (cytology)

Question 16

Treatment

Answer 16

lifestyle, H pylori eradication, drugs to reduce acid, treat drug induced ulcers

Question 17

what is the triple therapy for H pylori

Answer 17

full dose PPI, amoxicillin, clarithromycin (or metronidazole instead of amoxicillin)

Question 18

what drugs can be used to reduce acid

Answer 18

PPIs eg lansoprazole. H2 blockers eg ranitidine.

Question 19

how to treat drug induced ulcers

Answer 19

stop the drug. PPIs, misoprotol

Question 20

complications of ulcer

Answer 20

bleeding, perforation, malignancy, decr gastric outflow

Question 21

functional (non ulcer) dyspepsia

Answer 21

not an organic cause. could be increased visceral sensitivity, gastric delayed emptying etc. eradication H pylori may be helpful, some evidence for PPIs and psychotherapy.