Peptic ulcer.pptx
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Peptic ulcers form in the stomach or duodenum when gastric acid and pepsin damage the protective mucus layer of the digestive tract. Common causes include H. pylori infection, NSAID use, and stress. Symptoms vary depending on the ulcer location but often include abdominal pain relieved by food or antacids. Treatment involves lifestyle changes and medications to reduce acid production such as PPIs, H2 blockers, or antibiotics. Complications can arise if ulcers bleed, perforate, or cause blockages, so treatment aims to quickly heal ulcers and prevent future recurrence.
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Peptic ulcer.pptx
- 1. Peptic ulcer Dr Urmila Aswar
- 3. Start with the basic anatomy Parietal cells-HCl Chief cells- pepsinogen Endocrine cells- Gastrin, CCK, histamine
- 5. Phases of gastric juice secretion.
- 6. Proglumide ACh PGE2 Histamine Gastrin Adenyl cyclase _ + ATP cAMP Protein Kinase (Activated) Ca++ + Ca++ Proton pump K K+ H+ Gastric acid Parietal cell Lumen of stomach Antacid Omeprazole Ranitidine H2 M3 Misoprostol _ _ _ _ + PGE receptor + + Gastrin receptor + + +
- 7. Peptic ulcer Defect of mucosa related to the action of acid and pepsin in the gastric juice. Ulcers affect mucosa, submucosa and muscularis propria. Mostly in duodenum, less in stomach and very less in esophagus or jejunum. Happens when gastric juice (HCl and pepsin) is increased or defensive mechanism of mucus is decreased.
- 8. Etiology Psychological stress Physiological stress: shock, severe trauma, septicaemia, extensive burns, drug intake, Local irritants- alcohol, coffee, smoking Pathogenesis Reduction in production of bicarbonate Reduced production of Pgs: NSAIDS Increased acid production: Gastrin. Zollinger-Ellison syndrome Helicobacter pylori infection: stimulates acid secretion and inhibits bicarbonate production
- 9. Types They include gastric ulcers (those found in the stomach) and duodenal ulcers (those that are located in the top of the small intestine or duodenum). Peptic ulcers are common and usually occur singly. But it is possible to have two or more, or even both duodenal and gastric ulcers at the same time. Duodenal ulcers are more common than gastric ulcers.
- 10. Symptoms: Gastric ulcers Gastric ulcer pain may be less severe than duodenal ulcer pain and is noticeably higher in the abdomen Eating may increase pain rather than relieve pain Pain is described as aching, nagging, cramping or dull Other symptoms may include nausea, vomiting and weight loss Occasional painless bleeding, anemia (low blood count), or the passage of black, tarry stool may be the first sign of peptic ulcer disease. Some ulcers may produce no symptoms at all.
- 11. Symptoms: Duodenal ulcers Pain that awakens patients from sleep Burning or gnawing sensation in the upper abdomen Pain in the back, lower abdomen or chest area may occasionally occur Pain that occurs when the stomach is empty (about two hours after a meal or during the night). Relief frequently occurs after eating
- 12. Complications of ulcers Obstruction: Healing of ulcer produces obstruction called as stenosis. Eg Pyloric stenosis and duodenal stenosis Hemorrhage: minor bleeding by erosion of small blood vessels in the base of ulcer. Perforation: occurs in duodenal ulcers. The content escape from perforation into peritoneum leading to Peritonitis.
- 13. Clinical features Age: 50 yrs Stressed people ..leaders executives: DuoU Labor Group: GasU Periodicity: 2-6 weeks Pain: GasU: epigastric pain occurs within 2 hrs DuoU: Severe, during late night. Vomiting: GasU Haematemesis and malaena: Appetite: GasU: afraid to eat, DuoU: good appetite. Weight loss: GasU: common, DuoU: gain
- 14. HOW ARE PEPTIC ULCER DIAGNOSED Patients symptoms. Gastric function test: secretion of acid in stomach is monitoredBasal acid output (BAO) without stimulus and maximal acid output (MAO) under the influence of stimulus. Reading in mEq/L. Stimulus used : Histamine (0.04 mg/kg bwt), Pentagastrin etc. Tests for mucus: 1.8 mg/ml Serum gastrin level Test for IF Endoscopy
- 15. Complications Bleeding: iron deficiency anemia, pernicious anemia Perforation: peritonitis Penetration: Duodenal ulcer penetrating into pancreas Stenosis: Fibrosis that develops in the wall of the pyloric channel of the duodemum may cause narrowing of the lumen. It is associated with the food retention and vomiting
- 16. Treatment 1. Ulcercoating agents: Sucralfate. 2. Acid neutralising agents: antacids. 3. Medications medications that decrease the amount of acid produced by the stomach are used to provide quick pain relief and promote rapid healing. Eg antihistaminics: H2 blockers: ranitidine, cimetidine 4. Proton pump inhibitors: Inhibits H+K+ATPase present on gastric parietal cell: Omeprazole, lansoprazole 5. Ulcer healing drugs: Pgs analogue, proglumide 6. Antibiotics: tetracycline, amoxycillin used with PPI or ulcer protectives
- 17. Precautions Aspirin and anti-inflammatory products should be avoided. Medicine to be taken regularly.