Rohal.peptic ulcer
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  • 1. "Each time you are honest and conduct yourself with honesty, a success force will drive you toward greater success. Each time you lie, even with a little white lie, there are strong forces pushing you toward failure." alee
  • 2. Pathology of Peptic Ulcer By ali aziz
  • 3. Normal Stomach
  • 4. Esophagus & Stomach Normal
  • 5. Definition:
    • Ulceration (breach in mucosa) due to acid & pepsin attack – peptic ulcer.
    • Deeper than just mucosa
    • Single, punched out, clean base – why?
  • 6. Etiology: (study of causes)
    • Helicobacter pylori infection.(bacteria)
    • Hyperacidity –
    • Drugs - anti-inflammatory (NSAIDs) & Corticostroids.
    • Cigarette smoking, Alcohol,
    • Rapid gastric emptying
    • Personality and stress
  • 7. H. Pylori organisms- silver st.
  • 8. Pathogenesis: : (process)
    • Helicobacter pylori infection
    • Colonization of gastric mucous
    • Urease  ammonia  neutralization of acid  Rebound acid production.
    • Protease – Mucous break down.
    • Weak mucosal resistance
    • Acid & Pepsin digestion of mucosa
    • Chronic Ulceration
  • 9. Etiology of PUD Normal Increased Attack Hyperacidity Weak defense Helicobacter pylori * Stress, drugs, smoking
  • 10. Helicobacter pylori:
    • Most common infection in the world (20%)
    • 10% of men, 4% women develop PUD *
    • Positive in 70-100% of PUD patients.
    • H.pylori related disorders:
      • Chronic gastritis – 90%
      • Peptic ulcer disease – 95-100%
      • Gastric carcinoma – 70%
      • Gastric lymphoma
      • Reflux Oesophagitis.
      • Non ulcer dyspepsia
  • 11. Peptic Ulcer Morphology:
    • 90% ulcers in first portion of duodenum or lesser curvature of stomach(4:1).
    • 80 to 90% cases single ulcer. Round Small ulcers with sharply punched out edges*
    • Small <2cm, clean base*.
    • Microscopy: 4 zones.
      • Superficial necrotic layer.
      • Inflammatory cells zone.
      • Granulation tissue zone
      • Collagenous scar layer.
  • 12. Complications:
    • Bleeding – Chronic-IDA, Acute, Massive
    • Fibrosis, Stricture obstruction – pyloric stenosis.
    • Perforation – Peritonitis- emergency.
    • Gastric carcinoma. (not duodenal ca)
  • 13. Acute Esophagitis & Gastritis
  • 14. Gastric peptic ulcer:
  • 15. Gastric peptic ulcer:
  • 16. Gastric Ulcer
  • 17. Duodenal Peptic Ulcer
  • 18. Gastric Ulcer
  • 19. Peptic ulcer - Endoscopy
  • 20. Gastric Ulcer
  • 21. Gastric Ulcer
  • 22. Gastric Ulcer
    • Punched out ulcer
    • Clean base
    • Small single
    • Radiating mucosal folds.
    • Benign ulcer.
    • No tumor.
  • 23. Peptic Ulcer
  • 24. Peptic Ulcer Microscopy:
  • 25. Perforation:
  • 26. Acute Esophagitis & Gastritis
  • 27. Fungating
  • 28. Linitis Plastica – Schirrhous Carcinoma.
  • 29. Helecobacter pylori
    • Gram negative, Spiral bacilli
    • Spirochetes
    • Do not invade cells – only mucous
    • Breakdown urea - ammonia
    • Break down mucosal defense
    • Chronic Superficial inflammation
  • 30. PUD - Diagnosis
    • Endoscopy
    • Barium meal – contrast x-ray
    • Biopsy – bacteria & malignancy
    • H.Pylori:
      • Endoscopy cytology
      • Biopsy – Special stains
      • Culture - difficult
      • Urease Breath test.
  • 31. Points to Remember:
    • A peptic ulcer is a sore in the lining of the stomach or duodenum due to attack by acid & Pepsin.
    • The major cause - H. pylori bacterium. Others are NSAIDs. spicy food, stress are risk factors.
    • H. pylori can be transmitted from person to person through close contact
    • A combination of antibiotics and H pump inhibitors is the most effective treatment.
  • 32. Helecobacter pylori
  • 33. “ You get ulcer, not from what you eat, but from what’s eating you..!”