4. Peptic ulcer

Peptic ulcer disease

ulcers that occur in the lining of the sotmach, a gastric ulcer and those that develope in the small intestine- duodenal ulcer

PUD Pathophysiology

1. increased acid production- leads to damage of the mucosal lining

2. 2 damaged mucosal defences- damage to the natural defences that protect the stomach lining from acid

PU primary causes

• H pylori infection

• NSAIDs

• excessive gastric acid rpoduction

• smoking

H pylori infection

a bacteria that damages the stomach lining and increases acid production

NSAIDs

medications that inhibit prostaglandins naturally present in thr stomach to protect the stomach lining making the stomach more susceptible to damage from the stomach acid

excessive gastric acid production

if untreated can eventually begin to erode the stomach lining, all GORD risk factors apply

smoking

increases risk of H pylori infection and reduce the baility of the stomach to heal inself from damage

watch video

signs and symptoms

• abdominal pain in epigastric region at night (burning sensation)

• indigestion

• heartburn

• nausea + vomiting

• bloating

see GP urgently if

• pain gets worse

• lost appetite

• feeling full after small amounts of food

• unintentional weightloss

• pain when swallowing

go to A&E if

• vomitting blood/ vomit looks like ground coffe

• blood in stool or its black

• severe abdominal pain

• admoen tender to touch

• sudden chest pain

risk factors

• aged over 65

• high dose/ prolonged use of NSAIDs

• other drugs that increase risk of adverse gastrointestinal events (antiplatlets/antocouagulants/corticosteroids/SSRIs)

• heavy smoking

• excessive alcohol comsumption

• serious co-morbidity (cardiovascular disease, hypertension,diabetes,renal/hepatic impairment)

complications of PUs

• gastric perforation

• haemorrhage

• gastric outlet blockage

• increased risk of stomach cancer

gastric perforation

can lead to peritonitis, inflammation of the lining of the abdomen

haemorrhage

lead to iron deficieny anaemia, if blood loss is mild and ongoing

if the ulcer perforates the stomach where there is a large blood vessle

this could lead to suffen haemorrhage and hypovolaemic shock, when theres a sudden lack of circulating blood volume causing the body to shut down certain areas to ensure key areas remain perfused, which is life threatening

gastric outlet blockage

if an ulcer is close to the pylorus (exit of the stomach before the duodenum) is could cause inflammation and scarring which blocks the route stomach contets take to the GI tract

increased risk of stomach cancer

due to untreated H pylori infection

pharmacological managment

cause: H pylori infection positive and no NSAID use

treatment: h pylori eradication regimen

cause: NSAIDs use and no for H pylori infection

treatment: stop the NSAID where possible

full dose PPI or H2RA for 8 weeks

cause:NSAID use and positive for H pylori

treatment stop the NSAID wherer possible

full dose of PPI/H2RA for 8 weeks followed by H pylori eradication regiment

cause: negative for H pylori and no NSAID use history

treatment: PPI/H2RA for 4-8 weeks

mechanism of action

antibodies kill H pylori bacteria which is a primary cause of peptic ulcers

rationale for use

essential for curing ulcers caused by h pylori infections

perscribing information

check product literature for each medication prior to prescribing for dosage contra-indications, interactions etc

amoxicillin clarithomycin metrodonazole tetracycline

all abtibiotics

It is not fully understood how Bismuth exerts its effect, it is thought to be via various mechanisms.

The use of PPIs have been covered previously.

monitoring

monitor for eradication of H pylori and potential alergic reactions

side effects

gastrointestinal upset/ rash/potent9al allergic reactions

patient counselling points

complete the full course of antibiotics

report sever alergic reaction or persistent symptoms

non pharmacological managment

1. dietary changes

2. eat small frequent meals

3. lifestyle modications

4. limit alcohol comsumption’stress managment

5. avoid NSAIDs

dietary changes

reduction of caffine alcohol and smoking as they cna exasterbate symptoms

eat small freuent meals

helps avoid excessive stomach acid productio

lifestyle modifications

stomikg can delay ulcer healing and increase acid production

limit alcohom consumption

alcohol can irritate the stomach lining and worsen symptoms

stress managment

stress may exasterbate symptons to techiques like relaxation excersise orstress managment programes can be beneficial

avoid NSAIDs

the use of all NSAIDs should be reviewed for each patient. most will be advised to stop all NSAID use and consider alternative analgesia such as paracetamol