Peptic ulcer disease
Acute usually due to drugs (NSAIDs, steroids) or ‘stress’
Chronic drugs, H. pylori, hypercalcaemia, Zollinger-Ellison
Duodenal ulcer Gastric ulcer
4x more common than GU Lesser curvature of antrum
Pathology 1st part of duodenum Beware ulcers elsewhere (malignant)
M>F
H. pylori (95%) H. pylori (75%)
Drugs: NSAIDs/steroids Smoking, drugs
Smoking, alcohol Delayed gastric emptying
Risk factors Frequent gastric emptying Stress
Blood group O Cushing’s Intracranial disease
Curling’s burns, sepsis, trauma
Epigastric pain Epigastric pain
Before meals + @ night Worse on eating
Signs +
Relieved by eating/milk Relieved by antacids
symptoms
Weight loss
Ix Complications of PUD
Stool test – this is now the first line test. Tests for the
presence of H. pylori, put PPI’s must be stopped a week 1. Haemorrhage
before the test a. Haematemesis/
Urea breath test – if H pylori is present, any urea ingested malaena
ammonia absorbed by the body. Label the urea with b. Iron deficiency
an uncommon isotope (e.g. carbon13) detect the isotope anaemia
in the breath of the individual. If H. pylori is not present, the 2. Perforation peritonitis
urea will not be turned into ammonia, and thus will pass 3. Gastric outflow obstruction:
through the GI tract undigested, and the unusual isotope vomiting, colic, distension
will not be detected in the breath. 4. Malignancy: Increased risk of
Serum IgG – blood sample for IgG against H. pylori. Levels H. pylori
do not fall for many months after eradication, thus you
can’t use this test to see if treatment is successful. Complications of surgery
Endoscopy – anyone > 55 yrs, and/or with red flag Physical
symptoms. Enable biopsy (for cancer). Also, most patients Stump leakage
are scoped 6 weeks after treatment for ulcer to check for Abdominal fullness
cancer. Reflux or bilous vomiting (improves
FBC – to check for anaemia w/ time)
Faecal occult blood – not very specific Stricture
Gastrin levels Zollinger- Ellison suspected Metabolic
Mx
Dumping syndrome
Conservative
Abdominal distension, flushing,
Lose weight, stop smoking + alcohol, avoid hot drinks +
spicy food, stop drugs (e.g. NSAIDs, steroids), take OTC nausea + vomiting
antacids Early: osmotic hypovolaemia
Medical Late: reactive hypoglycaemia
OTC antacids Blind loop syndrome
H. pylori eradication triple therapy PAC500 (Contains malabsorption, diarrhoea
Amoxicillin)/PMC250 (Contains Metronidazole) full dose Overgrowth of bacteria in duodenal
suppression for 1-2 months stump
PPIs: Lansoprazole 30 mg OD Anaemia: Iron + B12
H2RAs: Ranitidine 300mg nocte Osteoporosis
Surgery Weight loss: malabsorption of
No acid no ulcer reduced calorie intake
Secretion stimulated by Gastrin + vagus nerve
Vagotomy, antrectomy, sub-total gastrectomy (w/ Roux-en-
Y)
Complications: stump leakage, abdominal fullness, reflux of
bilous vomiting, stricture
Acute usually due to drugs (NSAIDs, steroids) or ‘stress’
Chronic drugs, H. pylori, hypercalcaemia, Zollinger-Ellison
Duodenal ulcer Gastric ulcer
4x more common than GU Lesser curvature of antrum
Pathology 1st part of duodenum Beware ulcers elsewhere (malignant)
M>F
H. pylori (95%) H. pylori (75%)
Drugs: NSAIDs/steroids Smoking, drugs
Smoking, alcohol Delayed gastric emptying
Risk factors Frequent gastric emptying Stress
Blood group O Cushing’s Intracranial disease
Curling’s burns, sepsis, trauma
Epigastric pain Epigastric pain
Before meals + @ night Worse on eating
Signs +
Relieved by eating/milk Relieved by antacids
symptoms
Weight loss
Ix Complications of PUD
Stool test – this is now the first line test. Tests for the
presence of H. pylori, put PPI’s must be stopped a week 1. Haemorrhage
before the test a. Haematemesis/
Urea breath test – if H pylori is present, any urea ingested malaena
ammonia absorbed by the body. Label the urea with b. Iron deficiency
an uncommon isotope (e.g. carbon13) detect the isotope anaemia
in the breath of the individual. If H. pylori is not present, the 2. Perforation peritonitis
urea will not be turned into ammonia, and thus will pass 3. Gastric outflow obstruction:
through the GI tract undigested, and the unusual isotope vomiting, colic, distension
will not be detected in the breath. 4. Malignancy: Increased risk of
Serum IgG – blood sample for IgG against H. pylori. Levels H. pylori
do not fall for many months after eradication, thus you
can’t use this test to see if treatment is successful. Complications of surgery
Endoscopy – anyone > 55 yrs, and/or with red flag Physical
symptoms. Enable biopsy (for cancer). Also, most patients Stump leakage
are scoped 6 weeks after treatment for ulcer to check for Abdominal fullness
cancer. Reflux or bilous vomiting (improves
FBC – to check for anaemia w/ time)
Faecal occult blood – not very specific Stricture
Gastrin levels Zollinger- Ellison suspected Metabolic
Mx
Dumping syndrome
Conservative
Abdominal distension, flushing,
Lose weight, stop smoking + alcohol, avoid hot drinks +
spicy food, stop drugs (e.g. NSAIDs, steroids), take OTC nausea + vomiting
antacids Early: osmotic hypovolaemia
Medical Late: reactive hypoglycaemia
OTC antacids Blind loop syndrome
H. pylori eradication triple therapy PAC500 (Contains malabsorption, diarrhoea
Amoxicillin)/PMC250 (Contains Metronidazole) full dose Overgrowth of bacteria in duodenal
suppression for 1-2 months stump
PPIs: Lansoprazole 30 mg OD Anaemia: Iron + B12
H2RAs: Ranitidine 300mg nocte Osteoporosis
Surgery Weight loss: malabsorption of
No acid no ulcer reduced calorie intake
Secretion stimulated by Gastrin + vagus nerve
Vagotomy, antrectomy, sub-total gastrectomy (w/ Roux-en-
Y)
Complications: stump leakage, abdominal fullness, reflux of
bilous vomiting, stricture
