Peptic Ulcer

Exam Cram

• Peptic ulcer disease (PUD) incorperates stomach and duodenal ulcers

• Strong association with Helicobacter Pylori 

• Presentation: acute epigastric pain +/- upper GI bleed with NSAID use

• Management: emergency UGIB protocol, IV PPI, H.pylori eradication & endoscopy

Outline

Background

Strongly associated with H.pylori

Assessment

History

• Severe epigastric pain

• Upper GI bleed- haemoptysis (fresh red)

• Recent NSAID use

Examination

• Epigastric tenderness

• Can be peritonitic

• Can be septic

• H.pylori +ve

Investigations

• CTAP can show perforation

• Raised inflammatory markers (CRP, neutrophils)

• Unremarkable: urea, electrolytes, LFTs and lipase

Diagnosis & Classification

Diagnostic criteria

Classification

Management

Acute

• IV PPI infusion or 40mg IV BD

• NBM & maintenance slow IVF

• DW General Surgeons or Gastro ?endoscopy

• UGIB or major haemorrhage protocols

Endoscopy

• Neutralise ulcer

• H.pylori samples

Post endoscopy

• PPI 6 weeks

• Treat H.pylori & avoid NSAIDs

Med Reg Notes

Written in 2025