PEPTIC ULCER

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PEPTIC ULCER

TREATMENT

If H.pylori present: eradicate

Re-appearance= 1% per annum

Due to failed eradication rather then re-infection

False -ve of breath test

Clears 85-90%

2 out of 3:

Metronidazole

Clarithromycin

Amoxicillin

No acid= no ulcer: Proton Pump Inhibitor (PPI)

Duodenal ulcer

Never malignant

Nocturnal

Pain when hungry

Gastric ulcer

1% = malignant

Pain releived with food

INVESTIGATIONS

H. pylori

UREA breath test

Shud do 2 c if got rid of HP

Most sensitive

C13/ radioactive C14

Must biopsy if gastric ulcer as 1% are malignant

CLO test

Histology

Serology

Barium meal

Gastroscopy

ERECT CXR: gas/air under diaphragm = perforated ulcer

Blood tests

Amylase= >3 times upper limit of normal = Pancreatitis

Biochemistry: Electrolytes; Renal function (urea & creatinine); LFT's

FBC

Thrombo-cytopaenia = decreased platelet count

Chronic iron deficiency anaemia

CAUSE

NSAID's/ aspirin

H.pylori

HP= class 1/grade A carcinogen (like smoking with lung cancer)

= Risk factor (3-5 fold increase) for gastric carcinoma

Only HP has UREASE= enzyme that breaks down urea & produces CO2 (acid)

Gastric ulcer: found in 70% of cases with no NSAID's/ aspirin

Duodenal ulcer: found in 100% of cases with no NSAIDs/aspirin

Lives in gastric antrum

Acquired in childhood

Prevalence= 50% in 50yr olds; 20% in 20 yr olds

SYMPTOMS

Bleed/haemorhage: 15% mortality

Melena

Haematemesis

Perforation

Epigastric pain

Smoking= secretagon: increases acid production

Lasts for 4 weeks at a time

Eased with antacids

May radiate thru to back

Constant