Peptic Ulcer Disease

Reference: Davidson 23rd; P-799

Explanation: Endoscopy is the preferred investigation for diagnosis of peptic ulcer disease

Reference: Davidson 23rd; P-799

Stem Breakdown:

Epigastric pain, nausea, and vomiting: These are common symptoms of peptic ulcer disease (PUD).
Pain worsens after meals and improves with antacids: This suggests acid-related irritation, consistent with PUD. Antacids neutralise stomach acid, providing relief.
History of NSAID use: NSAIDs are a known risk factor for PUD because they inhibit prostaglandin synthesis, reducing the protective mucus layer in the stomach.
Option Analysis:

A) Peptic ulcer disease: This is the correct diagnosis. Davidson and Harrison explain that peptic ulcer disease is characterised by the formation of ulcers in the stomach or duodenum, often caused by NSAID use or Helicobacter pylori infection. NSAIDs disrupt the stomach’s protective mechanisms, leading to ulceration. Epigastric pain that worsens after eating and improves with antacids is typical of PUD.
B) Acute pancreatitis: Pancreatitis causes severe epigastric pain that radiates to the back, along with nausea and vomiting. The pain is typically worse after eating, but antacids do not relieve it. Pancreatitis is more often associated with elevated amylase and lipase levels.
C) Gallstones: Gallstones cause biliary colic, a sharp right upper quadrant pain that may radiate to the shoulder. The pain is not typically relieved by antacids, and gallstones are more common in women and those with risk factors like obesity and pregnancy.
D) Gastro-oesophageal reflux disease (GERD): GERD can cause epigastric pain and heartburn, but the pain is more likely to be retrosternal (behind the breastbone) and related to reflux of stomach acid into the oesophagus. GERD is associated with regurgitation and burning sensation rather than pain that improves with antacids.

Explanation: durug causes dyspepsia are NSAIDs, Glucocorticoids, Iron and potassium, supplements

Reference: Davidson 23rd; P-800
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd Box 21.15

Management
The aims of management are to relieve symptoms, induce healing and prevent recurrence. H. pylori eradication is the cornerstone of therapy for peptic ulcers, as this will successfully prevent relapse and eliminate the need for long-term therapy in the majority of patients.

Page-814

Explanation: persistent daily vomiting suggests gastric outlet obstruction

Ref: Davidson 23rd; P-1003 , box : 24.31

Reference: Davidson 23rd Fig. 21.19 most common cause of Upper GIT bleeding is PUD

Reference: Davidson 23rd; P-781

Explanation: Chronic gastric ulcer is usually single; 90% are situated on the lesser curve within the antrum or at the junction between body and antral mucosa

Reference: Davidson 23rd; P-775
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-800

Reference: Davidson 23rd; P-798
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-800

Reference: Davidson 23rd Box 21.37

Reference: Davidson 23rd; P-802
সলভ ক্লাসের জন্য আলোচনা পোস্ট দেখুন - [আলোচনা পোস্টের লিঙ্ক]

Reference: Davidson 23rd; P-800

Reference: Davidson 23rd; P-800

Reference: Davidson 23rd; P-798

Reference: Davidson 23rd; P-800

Reference: Davidson 23rd; P-799

Reference: Davidson 23rd; P-801