Peptic ulcer disease

Question 1

What is peptic ulcer disease

Answer 1

Gastric ulcer in the stomach or duodenum

Question 2

Forms of peptic ulcers

Answer 2

H pylori induced, NSAID induced, stress related mucosal damage

Question 3

Features of H pylori induced peptic ulcer

Answer 3

Chronic, more common in duodenum, more pH dependent, epigastric pain, superficial, bleeding less severe

Question 4

Features of NSAID induced peptic ulcer

Answer 4

Chronic, more common in stomach, less pH dependent, often asymptomatic, deep, more severe bleeding

Question 5

Features of SRMD ulcer

Answer 5

Acute, more common in stomach, less pH dependent, asymptomatic, most superficial, more severe bleeding

Question 6

What age group is h pylori most common in

Answer 6

Elderly

Question 7

How is h pylori transmitted

Answer 7

Poor hygiene

Question 8

What parts of GIT does h pylori affect

Answer 8

Duodenum and the stomach

Question 9

How does h pylori survive stomach acid

Answer 9

Has a layer of ammonia surrounding it

Question 10

Features of h pylori that allow it to infect GIT

Answer 10

Flagella to travel, adherence pedestals to stick to intestinal mucosa, ammonia layer to survive stomach acid

Question 11

MOA of NSAIDs

Answer 11

Inhibit cyclooxygenase which stops the inflammation but also inhibits prostaglandins which promote healing and repair damage

Question 12

Non selective NSAID

Answer 12

indomethacin, piroxicam, ibuprofen, naproxen, sulindac, ketoprofen, detorolac, flurbiprofen

Question 13

COX-2 NSAIDs

Answer 13

Etodolac, nabumetone, meloxicam, diclofenac, celecoxib

Question 14

Factors that increase incidence of NSAID induced GI bleeding and perforation

Answer 14

Older age, Hx of upper GI bleeding or peptic ulcer disease, h pylori infection, drugs that increase bleeding risk, significant comorbidity, smoking

Question 15

Why are OTC NSAIDs lower risk for PUD

Answer 15

Low dose, short duration of action, short term use

Question 16

Effect of smoking on PUD

Answer 16

Double risk, may delay wound healing

Question 17

Symptoms of PUD

Answer 17

Mild epigastric pain, burning abdominal pain, nocturnal pain, episodes of discomfort in clusters, heartburn, belching, bloating, nausea, vomiting, weight loss

Question 18

What medications have to be ceased to screen for PUD and for how long

Answer 18

No PPIs for 2 weeks and no ABX for 4 weeks

Question 19

1st line Tx to get rid of h pylori

Answer 19

Esomeprazole bd, amoxicillin bd and clarithromycin bd for 14 days

Question 20

Common causes of h pylori treatment failure

Answer 20

Antibiotic resistance, not taking for full duration, didn’t know to take all 3 drugs, didn’t follow directions

Question 21

How to treat h pylori if patient can’t take penicillin

Answer 21

Swap amoxicillin for metronidazole or if severe penicillin allergy PPI + colloidal bismuth subcitrate + tetracycline + metronidazole

Question 22

How to treat h pylori if clarithromycin not suitable

Answer 22

Swap for levofloxacin

Question 23

When to assess for h pylori eradication

Answer 23

4 weeks after finishing Tx

Question 24

How to check h pylori is gone

Answer 24

Urea breath test

Question 25

When is endoscopy required in h pylori

Answer 25

Gastric ulcers and complex duodenal ulcers

Question 26

Prevention of NSAID induced ulcers

Answer 26

Stop the NSAID, if not possible add PPI and go a COX2 selective or paracetamol if possible

Question 27

How to treat NSAID induced ulcers

Answer 27

Stop the NSAID and add a PPI at standard dose

Question 28

How to treat stress induced ulcers

Answer 28

PPI at standard dose

Question 29

What to do if ulcer starts bleeding

Answer 29

Surgery to stop the bleeding and give a PPI