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Peptic ulcer disease.

Peptic ulcer disease.

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  • 1. PEPTIC ULCER DISEASE Dr. M SHEKHANI
  • 2. Contents 1 DEFINITION 2 PATHOPHYSIOLOGY 3 AETIOLOGY 4 PREDISPOSING FACTORS
  • 3. Contents 5 6 D.DIAGNOSIS DIAGNOSTIC WORK-UP 7 MANAGEMENT 8 MEDICATIONS LIST
  • 4. Definition: • Mucosal defect in the lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to the stomach or, rarely, in the ileum adjacent to a Meckel’s diverticulum..
  • 5. Epidemiology: • M/F for DU 5:1 - 2:1, GU 2:1 or less. • Chronic gastric ulcer is usually single; 90% on the lesser curve within the antrum or body-antral junctio. • Chronic DU usually occurs in D1 just distal to the pyloric; 50% on anterior. • GU/DU coexist in 10% • > 1 PU is found in 10–15%.
  • 6. Pathophysiology H Pylori: in > 50% of gen population HP >90% DU >70% GU H Pylori NSAIDs Smoking 9O% DU,70% GU. In DU infect D cells leading to hypergastrinemia&hyperacidity. 30%;Impair mucosal defence through inhibiting PGs. Smoking > Complication & < healing. ?Genetics Rarely ZES NSAIDs
  • 7. Pathophysiology: How HP produces PUD. Adhesins (BabA)&(o ipA) Bacterial factors: vacA cagA •Smoking Host genetic polymorphisms: •IL-1β expression NSAIDs use.
  • 8. Clinical features: 40% vomiting In some Asymptomatic present with complications as GIB, Perforation. Daily vomiting? GOO R/Rs 30% atypical Elderly on NSAIDs: unease;anorexia Symptoms Poor predictors of PUD Presence.
  • 9. Investigations: Endoscopic biopsy: 1. For DU not needed because mostly benign except for HP diagnosis or if giant or atypical features( Crohns,TB,Ly mphoma,cancer). 2. For GU needed BZ may be malignant. nd E py co os HP test
  • 10. ZES:Gastrinoma 90%: Pan head or duodenum 50% multiple ½-2/3 malignant but slow growing 20-60% part of MEN1 Features: Short history Complicated more. Ulcers> in unusual sites, D2,Jej,eso. Unresponsive to trt. Recurs after surgery. Diarrhea in 50%. Diagnosis: Diagnosis: Serum gastrin 10-1000 fold increase& paradoxical inc with secretin. Localization by: EUS& SST Rec scintigraphy.
  • 11. Drugs for PUD: PPI/HSRAs/Antacids Acid suppresants: Mucosal resistance enhancers Both: Sucralfate/Carbinoxolone. Prpstaglandins.