"Peptic ulcer disease (PUD) encompasses a number of entities, united by the presence of mucosal ulceration secondary to the effects of gastric acid. Since the recognition of Helicobacter pylori as a common causative agent and the development of powerful anti-acid medications, peptic ulcer disease has become comparatively rare in western populations."
"Helicobacter pylori infection"
"The majority of cases are due to infection with Helicobacter pylori. This can be confirmed with biopsies obtained at endoscopy and urea breath test, the combination of the two resulting in a detection rate of close to 100% 4."
"Heliocobacter pylori, a spiral gram-negative bacterium has been identified as the leading cause of duodenal ulceration 2."
"Treatment depends on the clinical presentation. Historically emergent surgery for peptic ulcers was not uncommon, however the discovery of H. pylori and the ensuing revolution in management of the condition means that surgery is now rare as first-line therapy."
"When dyspeptic symptoms lead to identification of upper gastrointestinal ulceration (usually via endoscopy) patients are typically treated with acid-lowering medications and tested for Helicobacter pylori, which if found is then eradicated. This is important not only to prevent recurrence of peptic ulceration and reflux oesophagitis but also because it is associated with a number of malignancies including B-cell lymphoma and gastric adenocarcinoma 4."
"Helicobacter pylori infection"
Expected headings
"Fluoroscopy"
"Dyspeptic symptoms"
"Upper gastrointestinal haemorrhage"
"Perforation"
"severe physiological stress/illness (e.g. admission to intensive care)"
"In the acute setting, an erect chest x-ray is invaluable as it not only often allows the diagnosis of pneumoperitoneum to be made with confidence, but also gives treating clinicians important information of the patients' general health (e.g. cardiomegaly, aspiration pneumonia, pulmonary metastases)."
"Acute presentation with upper gastrointestinal haemorrhage requires expedient resuscitation, especially as the affected population is often relatively frail and hypotension/shock can lead to other medical sequelae (e.g. myocardial infarction, intestinal ischaemia)."
"vasoconstrictors (e.g. adrenaline/adrenaline)"
"sclerosing agents (e.g. alcohol)"
"coagulants (e.g. thrombin/fibrin)"
"generalised acute abdominal pain, peritonism and shock 2"
"Haemorrhage can be challenging to identify and requires a multi-phase scan without positive oral contrast (typically non-contrast, arterial and delayed phase scans are obtained) and the presence of active bleeding. Extravasation and pooling/accumulation of contrast into the lumen of the bowel may be seen."
"Perforation is a surgical emergency and in the vast majority of patients, laparotomy and repair of the perforation are performed."
"85% round; 15% linear"