Pathology of peptic ulcer with its introdution and types

1. PEPTIC ULCER
Mujahid Nadeem (13612)
Ali Raza (13621)
ArslanTahir (13635)
Ansar Ali Raza (13665)

2. CONTENTS
 INTRODUCTION
 TYPES
 ETIOLOGY
 PATHOGENESIS

3. INTRODUCTION

4. INTRODUCTION
Ulcer
 An ulcer is a discontinuity or break in a bodily
membrane that impedes the organ of which
that membrane is a part from continuing its
normal functions.

5. Types of Ulcers
Peptic ulcer
i. Esophageal ulcer
ii. Duodenal ulcer
iii. Gastric ulcer
Pressure ulcer
Genital ulcer
Ulcerative dermatitis
Anal fissure
Diabetic foot ulcer

6. Types of Ulcers (Cont.)
Corneal ulcer
Mouth ulcer
Venous ulcer
Stress ulcer
Ulcerative sarcoidosis
Ulcerative lichen planus
Ulcerative colitis
Ulcerative disposition

7. Peptic Ulcer
 Also known as “peptic ulcer disease” (PUD)
 Peptic ulcer is a break in the lining of the
stomach, first part of the small intestine, or
occasionally the lower esophagus.

10. Sites of peptic ulcer
 Duodenum …………….…… 80%
 Stomach …………………….. 19%
 Duodenum & Stomach ….. 4%
 GE junction …………………..
 Meckel’s diverticulum ……. 1%

12. Occurrence of peptic ulcer
 Serious medical problem
 Approx. 500,000 new cases each year
 5M people affected in USA only
 Mostly occur between 55 ot 65 years of age
 Duodenal ulcer more common in men than
women
 Gastric ulcer more common in women than
men

13. Occurrence of peptic ulcer
(Cont.)
 Duodenal ulcers are four times more
common than gastric ulcers
 Mortality rates from peptic ulcer are low
 High prevalence
 One of several upper GIT diseases that is
caused ,partially, by gastric acid
 Wide range of symptoms

14. Symptoms
Abdominal pain
• Located in epigastric area
• Burning in quality
• Occur on an empty stomach 2-4 hours after
meal or at night (nocturnal pain)
• Relieved by antacids
• Tend to wax and wane over months

15. Symptoms (Cont.)
Perforations
Blotting and abdominal fullness
Nausea and vomiting
Loss of appetite (because of pain)
Weight loss
Stomach obstruction
Heartburn
Hematemesis
Melena
Deep tenderness

16. TYPES OF
PEPTIC ULCER

17. Acute Peptic Ulcer
a. Cushing ulcer
b. Curling ulcer
Chronic Peptic Ulcer
a. Duodenal ulcer
b. Gastric ulcer
c. Esophageal ulcer
d. Bleeding ulcer
e. Refractory ulcer

18. Acute (Stress) Peptic Ulcer
Cushing Ulcer
Gastric, duodenal or esophageal ulcer arising in
patients with intercranial injury or operation
Curling Ulcer
Occuring mosty in the proximal duodenum and
associated with severe burns and trauma

20. Chronic Peptic Ulcer
Gastric Ulcer
A gastric ulcer is a sore that is on the inside of
the stomach
Causes
 Infection with Helicobecter pylori
 NSAIDs (e.g. aspirin, ibuprofen, diclofenac)

21. Chronic Peptic Ulcer (Cont.)
Duodenal Ulcer
The peptic ulcer having a sore on the upper part
of small intestine
Causes
 H.pylori
 Damaging of lining of mucosal wall

23. Chronic Peptic Ulcer (Cont.)
Esophageal Ulcer
 Open sores or lesions in the lining of
esophagus
 Mostly occur in the lower end of esophagus
Causes
 Associated with bad case of chronic gastro
esophageal reflux disease or GERD

25. Chronic Peptic Ulcer (Cont.)
Bleeding Ulcer
 Internal bleeding is caused by a peptic ulcer
which has been left untreated
 When this happens it is now referred to as
bleeding ulcer
 Most dangerous type of ulcer

27. Chronic Peptic Ulcer (Cont.)
Refractory Ulcer
These are simply peptic ulcers that have not
healed after at least 3 months of treatment

28. ETIOLOGY OF
PEPTIC ULCER

29. What Causes Ulcers?
 No single cause
 End result of an imbalance between digestive
fluids in stomach and duodenum
 Most common cause of ulcer is infection with
a type of bacteria called Helicobacter pylori
(H.pylori)

30. Factors that can increase
the risk of ulcers
 Use of NSAIDs (such as aspirin, naproxen,
ibuprofen and many others prescription
medicines; even safety-coated aspirin and
aspirin in powder form can cause ulcers
 Excess acid production from gastrinomas
(tumors of acid-producing cells)

31. Factors that can increase
the risk of ulcers (Cont.)
 Excessive drinking
 Smoking or chewing tobacco
 Serious illness
 Radiation treatment of the area

32. Who is more likely to get
ulcers?
Those people are more like to get ulcers who:
 Are infected with H.pylori
 Take NSAIDs (aspirin, ibuprofen or naproxen
etc.)
 Have a family history of ulcers
 Have another illness such as liver, kidney or lung
disease
 Drink regularly
Are age 50 or older

33. How are ulcers treated?
If not properly treated, they can lead to
serious health problems
Ulcers can be treated by following ways:
 Lifestyle changes
 Medication
 Surgery

34. Lifestyle changes
 Eliminate substrate that can causing ulcers
 Stop drinking and/or smoking
 Stop using NSAIDs

35. Ulcer Medication
Proton Pump Inhibitors(PPIs)
 Reduce acid level and allow ulcer to heal
 These include:
• Dexlansoprazole,
• Esomeprazole
• Lansoprazole
• Omeprazole
• Pantoprazole
• Rabeprazole
• Omeprazole/sodium bicarbonate etc.

36. Ulcer Medication (Cont.)
Antibiotics
 Used for H.pylori induced ulcers
 Multiple combinations of antibiotics are used
 Taken for 2-3 weeks along with PPIs

37. Ulcer Medication
Upper Endoscopy
 Bleeding ulcers can be treated using an
endoscope

38. Surgery
Surgery is needed if:
 Ulcer creates a hole in the wall of stomach
 There is serious bleeding that cannot be
controlled with an endoscope

39. How to reduce the risk of
developing ulcers?
 Don’t smoke
 Don’t drink
 Don’t overuse aspirin or NSAIDs
 If you have symptoms of ulcer, contact your
health care provider

40. PATHOGENESIS
OF PEPTIC
ULCER

41. H.pylori INDUCED ULCER
Gram negative bacteria produced heat shock proteins
Cytokines, histamine, lipopolysaccharides, certain
enzymes
Phospholipase
Urease, protease, fucosidase etc.
 Urease convert in acidic media urea into ammonia
and carbon dioxide. Ammonia itself cause
destruction of mucosal lining.

42.  Ammonia cause infection of mucosal lining and
ultimately inflammatory mediators release.
 Cytokines Leukocytes adhesion and
inflammatory reactions starts
Damage mucosa of GIT
Ulcer occurs

44. DRUG INDUCED ULCER
Drugs for example NSAIDS as aspirin(non
selectively inhibit cox1 and cox2 in human body
Arachidonic acid cox1,2 Prostaglandins
Controls gastric juice secretions
Damage mucosal lining lead to ulcer

45. STRESS INDUCED ULCER
In stress energy consumption increase so increase
glycolysis which is usually done by cortisol hormone
This hormone inhibit phospholipase A2
No arachidonic acid formation no prostaglandin
increase gastric juice secretions
Cause ulcer

46. STEROIDS INDUCED ULCER
Steroids acts on cell membrane (phospholipid)
Inhibit phospholipase
Inhibits arachidonic acid no prostaglandins and
damaging of mucosal lining

47. ULCER DUE TO GENETIC DEFECT
Rare genetics occurs some time having blood
group O positive the size of parietal cell is
increase
Increase cell demand as HCL secretions increase
Cause destruction of mucosal lining leading
towards ulcer

48. ZES(Zollinger-Ellison
Syndrome)
In this syndrome tumor of goblet cell occurs
Abnormal mucus secretions(gastrin acts on
parietal cells)
Increase secretions of gastric juice
Mucosal lining damage

51. THANKYOU
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