PEPTIC ULCER

Epigastric pain

Constant

May radiate thru to back

Eased with antacids

Lasts for 4 weeks at a time

Smoking= secretagon: increases acid production

Perforation

Bleed/haemorhage: 15% mortality

Haematemesis

Melena

H.pylori

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

Acquired in childhood

Lives in gastric antrum

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

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

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

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

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

NSAID's/ aspirin

Blood tests

FBC

Chronic iron deficiency anaemia

Thrombo-cytopaenia = decreased platelet count

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

Amylase= >3 times upper limit of normal = Pancreatitis

ERECT CXR: gas/air under diaphragm = perforated ulcer

Gastroscopy

Barium meal

H. pylori

Serology

Must biopsy if gastric ulcer as 1% are malignant

Histology

CLO test

UREA breath test

C13/ radioactive C14

Most sensitive

Shud do 2 c if got rid of HP

Pain releived with food

1% = malignant

Pain when hungry

Nocturnal

Never malignant

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

If H.pylori present: eradicate

2 out of 3:

Amoxicillin

Clarithromycin

Metronidazole

Clears 85-90%

Re-appearance= 1% per annum

False -ve of breath test

Due to failed eradication rather then re-infection