PEPTIC ULCERBY KHKULA IMTIAZROLL-NO:03

CONTENTS:DEFINITIONCLASSIFICATION SYMPTOMSCAUSESRISK FACTORSCOMPLICATIONSTESTS AND DIAGNOSIS CHARTTREATMENTLIFE STYLE AND HOME REMEDIES

DEFINITION: Peptic ulcers are produced by an

imbalance between the gastro-duodenal mucosal defense mechanisms and damaging forces of gastric acid and pepsin, combined with superimposed injury from environmental or immunologic agents.

Classification:Stomach (called gastric ulcer)Duodenum (called duodenal ulcer)Oesophagus (called Oesophageal ulcer)

Types of peptic ulcers:Type I: Ulcer along the lesser curve of stomachType II: Two ulcers present - one gastric, one

duodenalType III: Prepyloric ulcerType IV: Proximal gastroesophageal ulcerType V: Anywhere

Pathophysiology:

BicarbonateMucus layerProstaglandinsMucosal blood flowEpithelial renewal

Defensive

Helicobacter pyloriNSAIDsPepsinsBile acidsSmoking and alcohol

Aggressive

Mucosal damage erosions & ulcerations

ETIOLOGY:

H. Pylori Infection NSAIDsSmoking & AlcoholAcid HypersecretionStress Family History of PUD.

CLINICAL PRESENTATION

DUODENAL ULCER:Age: 30-40 yearsSex: More in MalePain: Epigastric region,discomfortOnset: 2 to 3 hrs after eating and midnightAgg.by: hungerRelived by: eatingVomiting: uncommonWeight: no wt lossHematemesis: 40%

GASTRIC ULCER:Age: middle age 50 to 60 yearsSex: more in FemalePain: Epi. Can radiate to backOnset: Immediately after eatingAgg.by: eatingRelived by:lying down or vomitingVomiting:common(to relive pain)Weight lossHematemesis: 60%

RISK FACTORS:You’re at risk for peptic ulcer disease if

you:Are 50 years old or older.Diabetes may increase your risk of having

H. pyloriDrink alcohol excessivelySmoke cigarettes or use tobacco.Have a family history of ulcer disease.

You’re at risk for NSAID-induced ulcers if you:Are age 60 or older (your stomach lining becomes

more fragile with age).Have had past experiences with ulcers and internal

bleedingTake steroid medications, such as prednisone.Take blood thinners, such as warfarin.Experience certain side effects after taking

NSAIDs, such as upset stomach and heartburn.Take NSAIDs in amounts higher than

recommended Take NSAIDs for long periods of timeStress does not cause an ulcer, but may be a

contributing factor

COMPLICATIONSGastrointestinal bleedingPerforationPenetrationScar tissue(obstruction)

TESTS AND DIAGNOSIS CHART:

Stool fecal occult blood.

CBC CBL.Rapid Urease test, urea breath test H.

Pylori.

Upper GI Endoscopy.

Barium meal X-Ray

TREATMENT

GOALS OF TREATMENT:

lowering the amount of acid that stomach makes,

neutralizing the acid protecting the injured area so it can healIt's also very important to stop smoking

and drinking alcoholPrevent complications (bleeding,

perforation, penetration, obstruction).

Life Style Change

Medical

Surgical

LIFE STYLE MODIFICATIONSmoking cessationAlcohol cessationStop using NSAIDsStress reduction

MEDICATIONSAntacidsH2-receptor blocking agents. Proton pump inhibitors.Cytoprotective and antisecretory drugs.Antibiotics.

SURGICAL Indications:

Failure of medical treatment.

Development of complications

High level of gastric secretion and combined

duodenal and gastric ulcer.

Principle:

Reduce acid and pepsin secretion.

VagotomyAnterctomyPyloroplastyHemigastrectomy

Thanks