Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

2025 Part Twos > Stomach: Peptic ulcer > Flashcards

Stomach: Peptic ulcer Flashcards

(91 cards)

Start Studying
1
Q

What is the definition of erosion in gastric or duodenal mucosa?

A

Erosion in gastric or duodenal mucosa that extends through muscularis mucosa

This definition pertains to the structural damage caused by peptic ulcers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the lifetime risk of developing peptic ulcers for men and women?

A

Approximately 10% for men and 4% for women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the trend in the incidence of peptic ulcers over time?

A

Reducing incidence over time due to reduction in H.pylori infection

The decline in H. pylori infections is linked to improved sanitation and antibiotic use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the common risk factors for peptic ulcers?

A
  • H. pylori (80-95% DU, 75% GU)
  • NSAID
  • Cigarette smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are less common risk factors for peptic ulcers?

A
  • Zollinger-Ellison syndrome
  • Steroids
  • Critical illness
  • Illicit drugs (crack cocaine, methamphetamine)
  • Alcohol
  • Marginal ulcer post bypass

These factors may contribute to ulcer development but are not as prevalent as the common ones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What regulates acid production in the stomach?

A

Acid released from parietal cells in response to histamine, gastrin, and vagal stimulation

This regulation is crucial for maintaining stomach acidity and digestive function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What stimulates the release of pepsin from chief cells?

A

Cholinergic stimuli and gastrin

Pepsin is essential for protein digestion in the stomach.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the role of bicarbonate in mucosal defense?

A

Bicarbonate continuously released from epithelium forming barrier across mucous layer to attack acid

This neutralization helps protect the gastric lining from acidic damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does the mucous layer protect against?

A
  • Pepsin
  • Acid diffusion
  • Bacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What occurs when the balance between peptic acid secretion and gastroduodenal mucosal defense is disrupted?

A

Ulceration occurs when balance disrupted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fill in the blank: Ulceration can occur with increased acid or decreased _______.

A

defence

This highlights the importance of both acid production and mucosal protection in ulcer formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the scientific name for H. pylori?

A

Helicobacter pylori

Commonly referred to as H. pylori.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the shape and characteristics of Helicobacter pylori.

A

Spiral/helical gram negative rod with 4-6 flagella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where can Helicobacter pylori be found in the human body?

A

Only in gastric mucosa and heterotopic gastric mucosa

Includes Barrett’s esophagus, gastric metaplasia in duodenum, Meckel’s diverticulum, and rectal heterotopic gastric mucosa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What enzyme does H. pylori produce, and what is its function?

A

Urease enzyme that breaks down urea into ammonia and bicarbonate

This creates an alkaline microenvironment for its survival.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the proposed mechanisms of GI injury caused by H. pylori?

A

Damages mucosal barrier, produces toxic products, induces local inflammatory reaction, hyper-acid secretion, increased gastrin levels

Includes ammonia, cytotoxins, mucinase, phospholipase, and platelet activating factor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What effect does H. pylori have on gastrin levels?

A

Increases gastrin levels, leading to increased gastric acid production

This is presumably due to reduction in antral D cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What condition allows H. pylori to colonize the duodenum?

A

Gastric metaplasia in the duodenum

This can lead to duodenitis and ulcer formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the mechanism of action of NSAIDs regarding COX enzymes?

A

Inhibit cyclooxygenase (COX) enzymes, inhibiting prostaglandin production

Prostaglandins promote gastric and duodenal mucosal protection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What functions do prostaglandins serve in the gastrointestinal tract?

A

Promote gastric and duodenal mucosal protection, increase mucin and bicarbonate production, increase blood flow to mucosa

Essential for maintaining mucosal integrity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the effect of NSAIDs on the risk of GI bleeding?

A

Increase risk of GI bleeding

Particularly in high-risk patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who are considered high-risk patients for GI bleeding when using NSAIDs?

A

> 60 years old, prior GI bleed, concurrent use of steroids or anticoagulants

These factors significantly elevate the risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some complications of peptic ulcers?

A
  • Bleeding
  • Perforation
  • Obstruction (gastric outlet)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do blood tests typically show in patients with ulcers?

A

Generally normal; may show iron deficiency anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What does Riggler’s sign indicate in an AXR?
Both sides of bowel wall visible due to air on both sides
26
What is the most reliable method for diagnosing ulcers?
Endoscopy
27
What is the sensitivity percentage of endoscopy for diagnosing ulcers?
90% sensitive
28
What type of biopsy is used for the diagnosis of H. pylori?
CLO biopsy
29
When should you biopsy an ulcer?
Depends on location and suspicion for malignancy
30
What features indicate a suspicious ulcer requiring biopsy?
* Ulcerated mass protruding into lumen * Folds surrounding crater are nodular, clubbed, fused or stop short of margin * Overhanging, irregular, thickened margin
31
Should you routinely biopsy gastric ulcers?
Yes, especially in patients with risk factors for gastric cancers
32
Should you routinely biopsy duodenal ulcers?
No, if the history and findings are typical for peptic ulcers
33
How should you take the biopsy from an ulcer?
Take from edge of ulcer and several samples
34
Where should you take a biopsy for H. pylori?
From gastric antrum
35
What is one invasive method to test for H. pylori?
CLO test
36
Describe the CLO test process
Biopsy of antral mucosa placed in urea medium; urease converts urea to ammonia, changing indicator color
37
What histology stain is used to increase sensitivity for H. pylori detection?
Giemsa stain
38
What is a difficult method to perform for H. pylori testing?
Culture
39
What is the best non-invasive test for H. pylori?
Stool antigen test
40
What do stool antigen assays assess?
Active infection and eradication
41
What must be done before the stool antigen test?
Stop PPI for two weeks
42
What does serology detect in H. pylori testing?
Presence of IgG
43
Why can't serology be used to assess eradication of H. pylori?
IgG remains elevated for 1 year
44
What is the process of the urease breath test?
Carbon labelled urea ingested, converted to ammonia and carbon dioxide; radiolabelled carbon dioxide is detected
45
What are the lifestyle modifications recommended for managing uncomplicated peptic ulcer disease?
* Stop NSAID and aspirin * Smoking cessation * Avoid alcohol and coffee
46
What is the function of medications in the management of uncomplicated peptic ulcer disease?
To either reduce acid or increase mucosal defence ## Footnote Medications play a crucial role in managing peptic ulcer disease by targeting acid production or enhancing the protective barriers of the stomach.
47
What is a proton pump inhibitor and its role in ulcer management?
Blocks H/K-ATPase of parietal cells, preventing acid secretion ## Footnote Proton pump inhibitors are more effective for ulcer healing compared to H2 antagonists.
48
How do H2 antagonists function in the treatment of peptic ulcers?
Block histamine signalling which reduces gastric acid production
49
What is the effect of antacids and when are they most effective?
Reduce gastric acid by reacting with hydrochloric acid to form a salt; best effect 1 hour post-meal ## Footnote Antacids are a quick relief option for acidity but are rapidly cleared when taken on an empty stomach.
50
What is the proposed mechanism of action for sucralfate in ulcer management?
Probably binds to protein in ulcer base to coat it ## Footnote Sucralfate is not part of initial management guidelines but is used for its protective properties.
51
What is the standard triple therapy regimen for H. pylori eradication?
* Amoxicillin 1g BD * Clarithromycin 500mg BD * Proton pump inhibitor ## Footnote This regimen is typically administered for 7-14 days and can be modified for penicillin allergies.
52
What should be done if symptoms improve after H. pylori treatment?
No further testing required ## Footnote Improvement in symptoms after treatment indicates successful management of the infection.
53
What is the recommended follow-up if a patient has persistent symptoms after initial management?
Further evaluation is required after 4 weeks ## Footnote Persistent symptoms may indicate a need for additional investigation to rule out complications or alternative diagnoses.
54
What test is used to confirm H. pylori eradication after treatment?
Stool antigen test after 4 weeks ## Footnote This test helps assess the effectiveness of the eradication therapy.
55
What actions should be taken for recurrent or resistant H. pylori?
Give second line treatment
56
What follow-up procedure is suggested after 8-12 weeks for patients with peptic ulcers?
Repeat OGD and consider taking biopsy of ulcers ## Footnote This follow-up helps assess healing and rule out malignancy.
57
What is the maintenance therapy recommended for peptic ulcer management?
Maintenance PPI therapy ## Footnote Long-term PPI therapy may be needed to prevent recurrence of ulcers.
58
What should be considered when evaluating a patient with recurrent symptoms?
Look for alternative pathology ## Footnote Persistent or recurrent symptoms may indicate other underlying issues beyond uncomplicated peptic ulcer disease.
59
What are the indications for surgical management in peptic ulcer disease?
Complicated PUD, Bleeding, Perforation, Obstruction - Gastric outlet, Suspected malignancy, Failure of medical management
60
What is the initial treatment for upper gastrointestinal bleeding?
Resuscitation, Reverse anticoagulant if required, Early use of PPI (loading dose of 80mg Omeprazole and then 72hrs infusion), +/- H.pylori eradication if testing positive, Prokinetic agent, Possible role for tranexamic acid ## Footnote Early use of PPI reduces risk of rebleeding from 20% to 3%.
61
What is the purpose of the Rockall score in risk stratification?
To stratify risk of re-bleeding mortality ## Footnote It is a composite score looking at age, shock, comorbidities, diagnosis, and recent hemorrhage.
62
What score indicates a low risk of further bleed or death according to the Rockall score?
2 or less
63
What does the Glasgow Blatchford score assess?
Urea, Hb, Systolic BP, other markers (pulse, melaena, syncope, hepatic disease, cardiac disease) ## Footnote A score of 0 predicts very low risk of re-bleed or death, making outpatient management appropriate.
64
What does Class I in the Forrest classification indicate?
It is bleeding now ## Footnote Class II indicates it was bleeding recently, and Class III indicates not bleeding.
65
What is the mortality risk associated with Class I in the Forrest classification?
Approximately 10% ## Footnote The risk of re-bleeding is very high in Class I, with about 1/3 needing surgery.
66
What is the risk of re-bleeding for clean based ulcers?
Very low ## Footnote Clean based ulcers have a significantly reduced risk of re-bleeding.
67
# Forrest classification What are the characteristics and re-bleed risks for a stage 1a and 1b ulcer
1a. Spurting bleed 60-100% 1b Oozing bleed 50%
68
What are the characteristics and dre-bleed risk for a IIa, IIb, IIC u
IIa:Non-bleeding visible vessel IIb: adherent clot IIc: flat spot in ulcer crater
69
70
What are the characteristics and re-bleed risk of a Forrest III ulcer?
III: clean base, 3-5%
71
What are the two recommended modalities for endoscopic treatment?
Injection and Thermal ## Footnote Injection involves volume tamponade, while thermal uses diathermy.
72
How does injection work in endoscopic treatment?
By volume tamponade ## Footnote 4 quadrant injection near bleeding point with adrenaline 1:10000.
73
What is the best practice for using thermal treatment?
Achieve mechanical tamponade first ## Footnote Thermal treatment is most effective after mechanical tamponade.
74
What is the effectiveness of haemoclips compared to injection alone?
More effective ## Footnote Haemoclips are often difficult to apply.
75
What is haemospray?
Nano-powder sprayed onto ulcer using pressurized carbon dioxide ## Footnote It is part of the mechanical treatment options.
76
What is the significance of using dual therapy?
More effective ## Footnote Dual therapy combines different modalities for better outcomes.
77
Is routine second look endoscopy required?
Not required unless concern about adequacy of haemostasis ## Footnote Routine follow-up is usually unnecessary.
78
What are predictors of failure in endoscopic treatment?
Ulcer size >2cm, lesser curvature ulcers, posterior or superior wall of bulbar duodenum ## Footnote These factors indicate higher risk of treatment failure.
79
What should be done if a patient re-bleeds?
Most can be managed with repeat endoscopy ## Footnote High-risk ulcers may benefit from surgery or angiography.
80
When should angiography be considered?
In patients who re-bleed following surgery or as an alternative to surgery ## Footnote Particularly useful for elderly, comorbid patients.
81
What has decreased the role of surgery in managing ulcers?
The rise of endoscopic and radiological management ## Footnote Endoscopic techniques are now preferred.
82
What are the surgical options for ulcer management?
* Simple under-running of ulcer * Vagotomy and pyloroplasty * Partial gastrectomy ## Footnote Studies on the benefits of these options were conducted before PPI and H. pylori treatment.
83
What is the mainstay surgical treatment for ulcers now?
Simple underrunning and ulcer biopsy. Ulcer is usually on the lesser curvature. ## Footnote Typically involves the use of 3'0 PDS.
84
What is the traditional management for visceral perforation?
Operative intervention required ## Footnote Some patients may be managed non-operatively if presenting early and stable, not peritonitic
85
What should be done for patients with perforation who are stable when considering non-operative management?
Consider CT with oral contrast to prove no ongoing leak ## Footnote Failure to improve indicates surgery.
86
What are the non-operative management steps for perforation?
* NG free drainage * NBM * IVF * High dose PPI * Close monitoring ## Footnote Failure to improve indicates surgery
87
What is the Graham-Steele repair?
Omental patch repair for perforation ## Footnote This method is used when omentum is available.
88
What should be done if there is no omentum available for repair?
Use falciform ligament, epiploic appendage, or jejunal patch ## Footnote These alternatives provide options for repair.
89
How should large ulcers (>2cm) be managed?
Closed around Foley and managed as a controlled fistula ## Footnote Most can still be managed with an omental patch.
90
What should always be done for gastric ulcers?
Biopsied ## Footnote Most can be managed with patch repair.
91
What is an acceptable biopsy technique for small ulcers?
Wedge excision ## Footnote This technique is effective for small ulcers

2025 Part Twos (74 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions