Categorie: Tutti - symptoms - treatment - diagnosis

da SHAMIM IQBAL mancano 17 anni

1760

PEPTIC ULCER

Peptic ulcers, which include duodenal and gastric ulcers, present differently in terms of pain and potential malignancy. Duodenal ulcers are never malignant and cause pain when hungry, often nocturnally, whereas gastric ulcers cause pain that is relieved with food but have a 1%

PEPTIC ULCER

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