Peptic Ulcer Disease (PUD)
Summary
Symptoms
Symptoms
- Epigastric/ deep retrosternal pain, relieved by antacids
- DU radiates to back
- Melaena
- Lethargy
- Hunger pains = DU, Postprandial pain = GU
- Meds (NSAIDs, steroids, SSRI)
- Smoking
- Epigastric tenderness
- Anaemia
- Bedside: C breath test (GOLD: for H pylori)
- Bloods: FBC, UEC
- Imaging: Gastroesophageoscopy (GES) + biopsy, CXR, CT
- Avoid triggers (food, smoking, meds)
- Triple therapy (Amoxicillin, Clarithromycin, Esomeprazole)
- PPI/ H2 blockers. misoprostol
- Surgery to repair perforation
Definition
Ulcerative lesion of gastric/ duodenal mucosa
Aetiology
Risk Factor
Epidemiology
Clinical Features
Symptoms
Signs
Investigations
Bedside: C breath test (GOLD: for H pylori)
Bloods: FBC (anaemia), UEC (baseline)
Imaging: Gastroesophageoscopy (GES) + biopsy (must rule out ca), CXR (air under diaphragm), CT (perforation)
Management
Complications
Source
OHCM 9th Ed 2014
Murtagh 4th Ed 2007
Ulcerative lesion of gastric/ duodenal mucosa
Aetiology
- H pylori (DU 90%/ GU 80%)
- Meds (NSAIDs, steroids, SSRI)
- inc gastric acid secretion
- Zollinger-Ellison syndrome (gastrin secreting tumour)
Risk Factor
- Meds (NSAIDs, steroids, SSRI)
- Smoking
Epidemiology
- DU 4 times more common than GU
Clinical Features
Symptoms
- Epigastric/ deep retrosternal pain, relieved by antacids
- DU radiates to back
- Malena
- Lethargy
Signs
- Epigastric tenderness
- Anaemia
Investigations
Bedside: C breath test (GOLD: for H pylori)
Bloods: FBC (anaemia), UEC (baseline)
Imaging: Gastroesophageoscopy (GES) + biopsy (must rule out ca), CXR (air under diaphragm), CT (perforation)
Management
- Avoid triggers (food, smoking, meds)
- Triple therapy
- PPI/ H2 blockers. misoprostol
- Surgery to repair perforation
Complications
- Bleeding
- Perforation
- Malignancy
Source
OHCM 9th Ed 2014
Murtagh 4th Ed 2007