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Q1: DU vs GU (2 min)
- DU: food-relieved, nocturnal, weight gain, ~never malignant
- GU: food-worsened, weight loss, always biopsy, confirm healing OGD[1]
Q2: H. pylori pathogenesis (2 min)
- Urease → ammonia cloud; CagA/VacA virulence; antral gastritis → acid dysregulation
- NSAIDs: COX-1 inhibition → prostaglandin loss → mucus/bicarbonate failure[1]
Q3: Perforation management (3 min)
- Board-like abdomen, free gas → ABC, NG, IV antibiotics, IV PPI, Graham patch[1]
- Anterior free perforation vs sealed perforation needing CT if equivocal[1]
Q4: Bleeding ulcer (3 min)
- Posterior DU → GDA; dual endoscopic therapy; PPI 80 mg then 8 mg/h × 72 h[3]
- Restrictive transfusion; IR or under-run if fails; Glasgow-Blatchford vs Rockall roles[2]
Q5: Eradication & resistance (3 min)
- Triple 14 d if clarithromycin resistance low; bismuth quadruple if high (much of India)[4][5]
- Test of cure UBT/stool Ag; off PPI 2 weeks; not serology[4]
Q6: GOO (2 min)
- Succussion splash, old food vomit; hypokalaemic hypochloraemic metabolic alkalosis
- NG, saline+K, PPI, OGD biopsy, dilatation vs surgery; exclude malignant GOO[1]
Q7: Historical acid surgery & dumping (2 min)
- Truncal vagotomy + drainage; HSV; Billroth I/II
- Early dumping (osmotic/vasomotor) vs late dumping (hypoglycaemia)[1]
Q8: ZES (2 min)
- Multiple/recurrent/jejunal ulcers + diarrhoea; fasting gastrin + low pH; MEN1 screen; high-dose PPI[6]
References6ShowHide
- [1]Tarasconi A, Coccolini F, Biffl WL, et al. Perforated and bleeding peptic ulcer: WSES guidelines World J Emerg Surg, 2020.PMID 31921329
- [2]Laine L, Barkun AN, Saltzman JR, et al. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding Am J Gastroenterol, 2021.PMID 33929377
- [3]Lau JY, Sung JJ, Lee KK, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers N Engl J Med, 2000.PMID 10922420
- [4]Fallone CA, Chiba N, van Zanten SV, et al. The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults Gastroenterology, 2016.PMID 27102658
- [5]Dutta S, Jain S, Das K, et al. Primary antibiotic resistance of Helicobacter pylori in India over the past two decades: A systematic review Helicobacter, 2024.PMID 38415810
- [6]Rossi RE, et al. Gastrinoma and Zollinger Ellison syndrome: A roadmap for the management between new and old therapies World J Gastroenterol, 2021.PMID 34629807