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Peptic ulcer
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Peptic ulcer


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  • 1. PEPTIC ULCER It means ulcer in those parts of gut which are exposed to acid. Duodenum and stomach are the most common sites. It can also occur in lower osophagus. Peptic ulcer is supposed to occur, either due to increased acid secretion(duodenal ulcer) or decreased mucosal resistance (gastric ulcer) or both. Two important etiological factors are
  • 2. • Infection by a bacterium (Helicobacter pylori) and NSAID ingestion. Zollinger Ellison syndrome is an uncommon cause of peptic ulcer. • In about 1/3 cases of peptic ulcer non of the above etiological factor is present. • There are multiple theories how H.pylori causes peptic ulcer. In patient of gastric ulcer there is gastritis involving whole of the stomach, resulting in impaired mucosal resistance. • In duodenal ulcer patients there is antral gastritis and loss of somatostatin secreting “D
  • 3. • “D Cells”which normally inhibit gastric secretion; end result is increased gastrin secretion and increased gastric acid output. This in tern causes injury to the duodenal mucosa. • NSAID induce ulcer due to inhibition of prostaglandins synthesis essential for normal mucosal defense. • Mechanism of ulcer not associated with H.Pylori or NSAID ingestion is not known. • Peptic ulcer pain is felt in the epigastrium and is well localized. Patient point with one finger to the site of pain- “the pointing finger”.
  • 4. • DUODENAL ULCER; it occurs in the first part of the duodenum. Symptoms; • pain is aggravated by empty stomach (hunger pain )and is relived by food and antacids. • Some times patient wake up after midnight due to pain. These nocturnal pain occurs because acid output is maximum at that time. • Pain which is present early in the morning is not due to peptic ulcer.
  • 5. • History of periodicity may be present (patient gets pain for days to weeks and then there is no pain for weeks to months without any treatmet). Signs; • There is localized tenderness in the epigastrium. Investigations ; • Barium meal shows duodenal deformity. • Endoscopy confirms the presence of ulcer.
  • 6. GASTRIC ULCER; Symptoms; • Relation of pain to meals and timing is variable. • It may be relived or aggravated by food. • Nocturnal pain is uncommon. Signs; Epigastric tenderness is usually present. Investigations; • Barium meal shows the ulcer crater. • Endoscopy confirms the presence of ulcer.
  • 7. • Every gastric ulcer must be biopsied to exclude malignancy. COMPLICATIONS OF PEPTIC ULCER; 1- Bleeding 2- Perforation 3- Chronicity 4- Gastric outlet obstruction