Peptic ulcers

Question 1

What is a peptic ulcer

Answer 1

Break in the mucosal lining with depth into submucosa due to an imbalance between acid secretion and mucosal protection.
Usually associated with H.pylori causing increased acid secretion from parietal cells

Question 2

Common site of peptic ulcer

Answer 2

Stomach
Oesophagus
Duodenum

Question 3

which parts of the duodenum are most at risk of developing a peptic ulcer

Answer 3

1st and 2nd

Question 4

Treatment

Answer 4

PPI
H2 antagonist
Stop NSAIDs

Most bleeding can be stopped endoscopically
Surgery required when ulceration causes perforation

Question 5

Risk factors

Answer 5

Most common:
-H.pylori is most common 
-smoking 
-NSAIDs 
-History of peptic ulcer disease (e.g. gastritis)
More rare:
-Crohns
-Zollinger-Ellison syndrome 
-Hyperthyroidism

Question 6

Symptoms

Answer 6

Main:
-Upper right abdominal/ retrosternal pain
-Pointing symptom- can point to sign of pain
-Noctural pain/hunger
More general:
-Weight loss
-Nausea
-Vomiting
-If ulcer bleeds can lead to hematiesis/ Malena

Question 7

Complications os peptic ulcers

Answer 7

• Perforation
• Stricture
• Acute bleed- if near a major vessel= hematesis
• Chronic bleed- If near a bunch of smaller capillaries: anaemia

Question 8

Investigation

Answer 8

• Physical examination and history
• Endoscopy
• H.pylori testing
• FOBT