Peptic Ulcers | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

216

Pages:

4
Author:

Mariam A. A.

Peptic Ulcers Epidemiology 30% of adults have H. pylori Higher in the elderly, migrants and people from low SES or internalised More common if a family member is infected More common in people with a personal history of peptic ulcer or gastric cancer Causes Common Less Common H. pylori Idiopathic Most common Stress ulcers NSAIDs Rare Ulcers visible at endoscopy of 15 to 30% of users Zollinger Elison syndrome Usually asymptomatic Crohn’s disease Those with longer half-lives are more likely to cause ulcers Viral infections Dose and duration -> increased risk Low dose aspirin -> increases risk -> primary prophylaxis with PPI Locations Duodenum Most common Stomach Clinical Features Epigastric pain Most common However, abdominal pain is a poor indicator that there is a peptic ulcer Dyspepsia Nasua Vomit Heartburn Melena More likely if: a remitting and relapsing course and nocturnal wakening with epigastric pain Differentiates it from GERD Personal or family history Use of aspirin or other NSAIDs Key Info Patients can have both peptic ulcers and GERD Relief by meal is not a reliable indicator if gastric or duodenal Investigations Urea breath test First line when H. pylori is suspected Ingestion of urea with C13 or C14 isotope -> CO2 production C13 is non-radioactive -> preferred in females looking to get pregnancy Can also test for eradication Faecal antigen test or serology Alternative Via enzyme immunoassay Can test for eradication Sensitivity is decreased if the peptic ulcer is bleeding Serology stays positive for years Endoscopy Gold standard Indicated if patient has red flags: Anaemia Dysphagia or odynophagia Haematemesis or melena Vomit Weight loss New symptoms in an older patient Changing symptoms Severe or frequent symptoms Inadequate response to treatment Atypical symptoms Findings: Mucosal break Ulcer Biopsy Most commonly for histology and/or a rapid urease test Endoscopy with multiple biopsies is the gold standard Detects associated pathological changes Should be taken from two sites of the stomach Rapid urease test Presence of H. pylori urease is indicated by a high pH. Sensitivity decreased by a bleeding ulcer Can identify presence of H. pylori or malignancy Accuracy is reduced if antibiotic therapy is used within the past 4 weeks or PPI within the past 2 weeks H2 antagonists do not have this effect