Flashcards in Peptic Ulcer Disease Deck (9):
Ulceration in stomach or duodenum due to imbalance between mucosal protective factors and damaging mechanisms.
Must cross muscularis mucosa.
Common in 1st part duodenum and lesser curve.
Normal defences- mucous, HCO3, BF, PG, epithelial t/o.
H pylori urease=NH3
Drugs eg NSAIDs, glucocorticoids
Smoking, alcohol dissolves mucous
Massive stress eg burns=reduced immune function
Incompetent pylorus or LOS
Impaired proximal duodenal bicarb secretion
Decreased BF to gastric mucosa
Acid secreted by parietal cells and pepsinogen secreted by chief cells.
Neoplasm eg gastric, lymphoma, pancreatic.
Angina, MI, pericarditis
Dissecting aneurysm, AAA
High SI obstruction
Stop smoking and alcohol.
Avoid or replace NSAIDs
H2 antagonists eg ranitidine
PPI eg omeprazole
H pylori triple therapy- PPI, amoxicillin, clarithromycin.
Antacids and sucralfate
Epigastric pain can radiate to back. Associated with hunger or after eating certain food. Can be worse at night.
Bloating. Early satiety. Heartburn. Nausea. Fat intolerance.
ALARM Symptoms- Anaemia, Loss of weight, Anorexia, Recent onset/progression, Malaena and haematemesis, swallowing difficulty.
Epigastric pain before meals of at night. Relieved by eating or drink milk. 50% asymptomatic, others experience recurrence.
Asymptomatic. Epigastric pain. Possibly weight loss.
Peritonitis if perforate
gastroduodenal A behing duodenum so bleeding.
Haematemesis or malaena if BV erosion.
Scarring of duodenum can=pyloric stenosis with vomiting and weight loss.
Slight increase risk gastric CA.
Urease breath test
FBC for anaemia
Upper GI endoscopy especially if progressive dysphagia, vomiting, epigastric mass, iron deficiency.