The incidence of peptic ulcer diseases is decreasing worldwide due to the availability of proton pump inhibitors and better suppression of acid secretion. However the complications of peptic ulcer like bleeding and obstruction have remained unchanged. Here are a few questions on peptic ulcer. For more questions on stomach and duodenum check out the links on left
Q 1. Most common site of gastric ulcer is
a) Incisura
b) Greater curvature stomach
c) Fundus of stomach
d) Antrum
Q2. One of the follwing is not a surgery for duodenal ulcer disease
a) Taylor
b) Hill Baker
c) HSV (Highly selective vagotomy)
d) Lewis
Q3 Which of the following is not a sign of malignant gastric ulcer on radiographic studies?
a) Carmen sign
b) Hampton's line
c) Nodular gastric ulcer mound
d) Abrupt transition between normal and abnormal mucosa several cms away from the ulcer crater.
Q4. Which of the following is not a poor predictor of response of bleeding gastric ulcer to endoscopic therapy?
a) Large size of ulcer
b) Active bleeding at the time of endoscopy
c) Stomach ulcer at the lesser curvature
d) Ulcer at the anterior duodenal location
Answers
1. a
Types of gastric ulcer
Type I ulcer - commonest --A type I gastric ulcer is typically located along the lesser curvature of the stomach, usually at the antral-fundic junction, and is associated with acid hyposecretion.
Type II ulcer - Occurs in conjunction with active or healed duodenal ulcer disease.
Type III- Prepyloric ulcer
Type IV ulcer - Gastro esophageal junction at the lesser curve
Type V ulcer- Anywhere in the stomach associated with chronic NSAID use or aspirin use
2. d
Lewis operation is not a gastric ulcer surgery .It is a radical two field esophagectomy
Taylor procedure is for ulcer of the stomach and duodenum. It is a laparoscopic posterior vagotomy with anterior seromyotomy
Hill Baker is laproscopic posterior vagotomy and and anterior highly selective vagotomy.
3. b
The signs of malignant gastric ulcer on barium examination are..
1.Eccentrically located ulcer within the ulcer mound.
2. Irregularly shaped ulcer crater
3. Nodular ulcer mound
4. Abrupt transition between normal and abnormal mucosa several cms away from the ulcer crater
5. Rigidity, lack of distensibility and lack of changeability
6. Associated large mass
7. Carmen meniscus sign-a relatively shallow gastric ulcerating malignancy projecting as an ulcer which is always convex inwards to the lumen and which does not project beyond the wall
8. Ulcer projects within the anticipated wall of the stomach
Sigs of benign gastric ulcer are
Hampton’s line-1 mm thin straight line at neck of ulcer in profile view which represents the thin rim of undermined gastric mucosa
4. d
Failure of endoscopy during excessive bleeding from a gastric ulcer means that a surgical intervention will be likely.
All these are predictive factors for failure of endoscopy except placement of ulcer on the posterior wall of duodenum. Ulcer on the posterior duodenal wall is difficult to be approached during endoscopy.
