Discuss the causes, symptoms and dietary management of peptic ulcer.

1. 1 · Open in two lines. A peptic ulcer is an open sore in the stomach or duodenum caused by acid and pepsin. H. pylori and NSAIDs cause most ulcers.
2. 2 · Draw the sites. [Sketch: stomach and duodenum with a gastric ulcer and a duodenal ulcer marked]
3. 3 · Causes and types.
   • H. pylori, NSAIDs, smoking, alcohol, stress, irregular meals.
   • Gastric vs duodenal: timing of pain.
4. 4 · Symptoms and complications. Epigastric burning pain, nausea, bloating; bleeding, perforation, obstruction, anaemia.
5. 5 · Old vs modern diet. Sippy and bland diets have given way to small frequent normal meals avoiding only irritants and foods that cause pain.
6. 6 · Principles, foods and menu. Meal pattern, energy, protein, fat, irritants, iron; include and avoid lists; a six-meal menu.
7. 7 · Close in one line. Drugs heal the ulcer; regular, gentle meals keep it from coming back.

Scoring tip: Mention the Sippy diet and why it was dropped; it shows the examiner you know current practice.