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home - Stomach - Peptic Ulcer Disease - Peptic Ulcer Disease Pathophysiology Written by Dr Sebastian Zeki
Knowledge

Knows the range of organic and non-organic causes of dyspepsia. Be
aware of current BSG and NICE guidelines for selecting patients for
investigation. Know the significance of alarm symptoms
Understands the relevance of Helicobacter pylori infection and how it
can be detected and treated.
Recognise the adverse effect of nonsteroidal anti-inflammatory drugs
Understands the physiology of gastric acid secretion, mucosal
protection and gastroduodenal motility and know how drugs can
modify these
Knows the complications of ulcer disease, the principles of surgery
that may be required and be aware of post-operative sequelae

Skills
Makes a thorough clinical assessment, perform appropriate
investigations and be familiar with how medical treatments are used.
Show awareness of how to recognise and manage complications

Behaviours
Can explain the steps taken towards making a diagnosis and
planning treatment clearly and comprehensibly

Also....

Knowledge
Knows the causes of upper gastrointestinal bleeding and its
presentation
Understands the circulatory disturbance associated with blood loss
and the pathophysiology underlying the clinical manifestations of
hypovolaemic shock
Knows the principles of assessing hypovolaemia and of restoring the
circulation. Be able to identify and correct coagulopathy
Knows the principles of using the various risk stratification tools SCE 1
Knows how endoscopic techniques are used to control bleeding CbD, DOPS, SCE 1
Understands how oesophageal and gastric varices develop and the
endoscopic and pharmacological methods that are used to control
blood loss

Skills
Can make an accurate clinical assessment, and stratify the risk. Know
the principles of fluid resuscitation and arrange endoscopy
Is aware of methods to secure haemostasis, recognise signs of rebleeding and liaise with other disciplines (such as interventional
radiology or surgery

Behaviours
Assesses and treats patients who have bleeding with appropriate
degree of urgency.

Also...
Knowledge


Understands why part or all of the patient’s stomach is removed and
the altered post-surgical anatomy

Understands the problems of a gastro-enterostomy and a Roux-en-y
anastomosis

Has awareness of dumping syndromes
Knows the various surgical operations performed for obesity (bariatric
surgery) and their complications

Skills
Can give nutritional advice and choose the appropriate method by
which an enteral feeding tube is inserted into the small bowel

Can initiate the use of pancreatic enzyme therapy
Has ability to recognise and treat early and late dumping syndrome
Behaviours
Able to help the patient carers friends and family understand how
the patient can be encouraged to gain weight

Works closely with dieticians and surgical colleagues

Peptic Ulcer Disease Pathophysiology

Proximal Gastric ulcer — Usually associated with low-normal or low acid secretion, reflecting a low normal parietal cell mass corresponding to the encroachment of oxyntic mucosa by advancing antritis and oxyntic gland atrophy Hypergastrinaemia H+ DU May also have meal responsive hypergastrinaemia but not fasting hypergastinaemia Gastric Acid Hypersecretion Impaired duodenal bicarbonate secretion(induced by H. pylori) Lowered pH Gastric metaplasia in duodenum Induces duodenitis H. pylori Duodenal Ulceration Distal gastric ulcer -In contrast to GU involving the gastric body, patients with ulcers in the distal antrum or GU associated with concurrent DU have normal or even increased levels of acid secretion. Gastric ulceration Ulcer Pathophysiology Vagal hyperactivity. H.pylori Suppression of somatostatin Aetiol-ogy with H. pylori Aetiol-ogy with-out H. pylori + + Written by Dr Sebastian Zeki

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