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Common Peptic ulcer disease exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1. Causes of peptic ulcer disease (PUD)

What are the causes of peptic ulcer disease?

  • H. Pylori (approx. 80%)
  •  Drugs
    • Aspirin
    • NSAIDs
    • Steroids
  • Smoking
  • Alcohol
  • Stress
    • Curling’s ulcer (burns – sloughing of mucosa due to plasma loss)
    • Cushing’s ulcer (raised intracranial pressure – changes to vagal tone)
  • Acid hypersecretion
    • Zollinger-Ellison – gastrin-secreting tumour (gastrinoma)
      • Responsible for 1/1000. Multiple ulcers.
      • Treat with high-dose PPI (or curative resection)
    • Small bowel resection (loss of feedback)
    • Systemic mastocytosis (increase histamine production)
  • Abnormal gastric emptying
    • Too fast can give duodenal ulcers,
    • Too slow can cause gastric ulcers + sucussion splash

 

 Question 2. Complications of PUD

What are the complications of peptic ulcer disease and H pylori infection?

  • Haemorrhage:
    • Controlled endoscopically
    • Adrenaline, diathermy, laser coag, heat probe.
    • Bleeding ulcer base can be undersewn in a proper operation
  • Perforation:
    • Conservative approach (NBM, NG, IV ABx) can prevent surgery in up to 50%, if no generalised peritonitis present
    • Laparoscopic repair of hole
  • Pyloric stenosis (late complication – lots of vomiting)
    • Balloon dilatation + PPIs
    • If ineffective, drainage procedure (e.g. pyloroplasty)
  • MALT lymphoma
    • B-cell
    • Metastases are rare
    • Associated with paraproteins and pseudohyponatraemia
    • H.Pylori eradication leads to regression in 80%
  • Gastric cancer
    • VacA and CagA strains of H pylori appear to be associated with an increased risk of gastric cancer