Lecture Notes on Peptic Ulcers

Introduction

• Presenter: Tom from ZeroToFinals.com
• Reference materials available at ZeroToFinals.com/peptic-ulcers and in the gastroenterology section of the ZeroToFinals Medicine book.

What are Peptic Ulcers?

• Definition: Ulceration of the mucosa of the stomach or duodenum.
  • Gastric ulcer: Ulcer in the stomach.
  • Duodenal ulcer: Ulcer in the duodenum; more common than gastric.
• Protective Layer: Mucus and bicarbonate secreted by the stomach mucosa protect against acid.
• Breakdown Causes:
  • Medications: Steroids, NSAIDs (e.g., ibuprofen, naproxen).
  • Bacteria: Helicobacter pylori.
  • Increased stomach acid due to stress, alcohol, excessive caffeine, smoking, spicy foods.

Symptoms of Peptic Ulcers

• Epigastric discomfort or pain.
• Tenderness to palpation.
• Nausea and vomiting.
• Dyspepsia (indigestion symptoms).
• Bleeding Symptoms:
  • Hematemesis (vomiting blood).
  • Coffee ground vomit (digested blood).
  • Melina (tarry black stools).
• Chronic bleeding can cause iron deficiency anemia, a common presentation of gastric ulcers or cancer.

Exam Tips

• Eating worsens gastric ulcer pain.
• Eating improves duodenal ulcer pain.

Diagnosis and Management

• Diagnosis:
  • Endoscopy to visualize and assess ulcers.
  • CLO test (rapid urease test) for H. pylori.
  • Possible biopsy to exclude gastric cancer.
• Medical Management:
  • High dose proton pump inhibitors to reduce stomach acid.
  • Endoscopy for monitoring ulcer healing and detecting further ulcers.

Complications of Peptic Ulcers

1. Bleeding:
   • Low-level bleeding: Causes chronic iron deficiency anemia.
   • Large hemorrhage: Potentially life-threatening.
2. Perforation:
   • Ulcer creates a hole in the stomach.
   • Causes peritonitis and requires urgent surgical repair.
3. Scarring and Strictures:
   • Ulcer heals into scar tissue.
   • Causes pyloric stenosis (narrowing of the pylorus).
   • Symptoms: Upper abdominal pain, distension, nausea, vomiting, reflux.

Conclusion

• Additional resources available on the Zero to Finals website.
• Options for further learning: Notes, test sections, and a blog about a career in medicine.
• Encouragement to engage with the Zero to Finals YouTube channel for updates and more content.