Peptic Ulcers

Question 1

Definition

Answer 1

A break in the epithelial cells with penetrate down to to muscular is mucosa of either the stomach or the duodenum

Question 2

Epidemiology

Answer 2

More common in elderly
More common in developing countries- H.pylori
Duodenal most common 90%- relieved by eating
Gastric worsened by eating
Risk factor for gastric cancer- constant inflammation

Question 3

Symptoms

Answer 3

Burning epigastric pain
Bloating
Vomiting
Nausea
Flatulance
Dyspepsia
Haematemesis

Question 4

List of causes

Answer 4

H. Pylori
NSAIDS
Mucosal ischaemia 
Inc acid
Bile reflux
Alcohol

Question 5

How does H. Pylori cause

Answer 5

Lives in gastric mucus
Secretes urease
Splits urea into CO2 and ammoni
Ammonia + H+ = ammonium
Ammonium damages epithelium
Causes inflammation response
Reduces mucosal defence =mucosa damage
Inc acid secretion:
-gastrin release 
- histamine release
-Inc parietal cell mass
-decr somatostatin

Question 6

Treatment for H. Pylori

Answer 6

Omeprazole
Clarithromycin
Amoxicillin

Question 7

How NSAIDS cause

Answer 7

Inhibits mucus secretion= mucosal damage
Mucus secretion stimulated by prostaglandins
Require COX-1 for prostaglandins synthesis
NSAIDS inhibit COX-1

Question 8

How mucosal ischeamia causes

Answer 8

Stomach cells not enough blood
Cells die
Don’t produce enough mucin 
Gastric acid attacks cells
Cell death= ulcer

Question 9

Treatment for mucosal isheamia

Answer 9

H2 blocker

Question 10

How increase acid causes

Answer 10

Overwhelmed mucosal defence
Too much acid
Acid attacks mucosal cells
Cell death= ulcer

Question 11

Treatement for increase acid

Answer 11

PPI + h2 blocker

Question 12

How bile reflux causes

Answer 12

Duodenal gastric reflux
Bile strips mucus layer
Reduced defence

Question 13

Signs for gastric ulcer

Answer 13

Pain occurs when hungry/eating
Occurs at night
Causing weight loss

Question 14

Duodenal ulcer signs

Answer 14

Occurs after eating
Weight gain
Relieved by eating

Question 15

Red flags for cancer instead

Answer 15

Weight loss 
Anaemia
GI bleeding
Dysphagia 
Upper abdominal mass
Persistent vomiting

Question 16

Investigations

Answer 16

Endoscopy with biopsy
Stool antigens test -H. Pylori
Urea breath test
Blood test for IgG antibodies- positive after year of treatement

Question 17

Management

Answer 17

Lifestyle changes
Stop NSAIDS
PPIs
H2 antagonists
Surgery for complications

Question 18

Complications

Answer 18

Duodenal ulcer can grow deeper and hit and artery causing haemorrhages and strokes

Perforation
Obstruction
Peritonitis if acid reaches peritoneum
Acute pancreatitis if ulcer reaches pancreas