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PEPTIC ULCERS - Coggle Diagram
PEPTIC ULCERS
DEFINITION
Erosion of the mucosa in the stomach and/or duodenum
ETIOLOGIES
H. pylori
Releases toxins (ammonia)
NSAIDs
Direct toxicity
COX-1 inhibition causes decreased prostaglandins
Ischemia
Decrease in gastroprotective factors
Mucous
Blood flow
Epithelial cells
Prostaglandins
Pancreatic secretions (neutralize acid)
Increase in injurious substances
Acid
Toxins
PATHOPHYSIOLOGY & COMPLICATIONS
Erosion of mucosa
Bleeding
Hematemesis (coffee grounds)
Melena stool
Perforation
Intraperitoneal leaking
Referred pain to shoulder
Malignancy (gastric carcinoma)
INVESTIGATIONS
Endoscopy
Tests for H pylori
Biopsy urease (detection of ammonia in biopsy specimen)
Histology
Bacterial culture
Urea breath testing - using radiolabeled carbon in urea and detecting CO2
Stool antigen testing
Serology (IgG antibodies in the blood)
TREATMENT
Lifestyle: decrease alcohol and tobacco
H pylori eradication: triple therapy
PPI
Clarithromycin
Amoxicillin
PPIs, H2 blockers, antacids
ALARM symptoms
Anemia
Loss of weight
Anorexia
Recent onset/progressive symptoms
Melena stool/hematemesis
Swallowing difficulty