Peptic Ulcer

Question 1

What causes peptic ulcers?

Answer 1

H Pylori

NSAIDs

Zollinger Ellison syndrome

Question 2

What is Zollinger Ellison syndrome?

Answer 2

A gastrin secreting adenoma or hypertrophy of the islets leading to increased gastric acid secretion

Question 3

How was it discovered that H pylori caused ulcers?

Answer 3

Barry Marshall drank cultures of h pylori to give himself an ulcer

Question 4

What are the symptoms of Peptic ulcers?

Answer 4

Pain

Nausea and vomiting

• Haematemasis if the ulcer erodes into an artery in the stomach
• Meleana if it’s duodenal

Weight loss

Question 5

Which artery is perforated and where does the ulcer have to be to cause meleana?

Answer 5

Gastroduodenal artery

- Posterior duodenum

Question 6

Which artery is perforated in gastric ulcer and where does the ulcer have to be?

Answer 6

Coeliac plexus branches

- Lesser curvature

Question 7

Which is more common GU or DU?

Answer 7

DU

Question 8

Symptoms of GU/DU?

Answer 8

Epigastric pain
- Typically at night

Asymptomatic

Question 9

Signs of GU/DU?

Answer 9

Epigastric tenderness

Question 10

Investigations?

Answer 10

Upper GI endoscopy
- Multiple biopsies

H. Pylori testing

Measure gastrin levels if Zollinger Ellison suggested

Question 11

Lifestyle treatment?

Answer 11

Avoid food that worsens symptoms

Stop smoking

Question 12

What pharmacological treatment can be done?

Answer 12

Triple therapy H Pylori eradication

• PPI
• Amox
• Clarith

Keep PPI on for acid reflux symptoms

Question 13

Surgical treatment?

Answer 13

Selective vagotomy