4. GERD –esophageal ulcers
Increased secretion of HCl – Stress
Spicy food, caffeinated beverages, smoking, alcohol.
Familial tendencies
Blood group O
Burns – Curling’s ulcers observed after 72 hours of extensive burns
Head injury and brain trauma - Cushing’s ulcers in patients.
5. Increased concentration of acid – pepsin or decreased
resistance of mucosa
Slight erosion of mucosa
Damaged mucosa cannot secrete enough mucus that
acts as a barrier to the HCl
Decreased resistance of mucosa to bacteria thereby
making it susceptible for H pylori infection.
Infection further deeply damages the stomach involving
the muscle layers
Sometimes, perforation occurs leading to peritonitis
6. Dull, gnawing pain occuring 1.5 to 3 hours after meals
Sharply localized tenderness
Heartburn on burping
Nocturnal epigastric pain
Early satiety
Anorexia, weight loss
Dizziness, syncope, hematemesis, melena
Anemia
7. History Collection
P.E – pain, epigastric tenderness, abdominal distension.
Upper G.I endoscopy with tissue biopsy
Pylori tek – biopsy urea test
Upper G.I radiographic examination (Barium meal)
Stool examination for occult blood
Gastric secretory studies (serum gastric level test)
Serological test to detect presence of H pylori
antibodies.
8. Goal is to eradicate H pylori infection and to manage
gastric acidity
Pharmacological Therapy:
10 – 14 days Antibiotics (metronidazole,
amoxicillin,clarithromycin), proton pump inhibitors
and bismuth salts.
H2 receptor antagonists and proton pump inhibitors are
used to treat NSAIDS induced ulcers.
Rest, sedatives and tranquilizers can be given for
comfort.
9. In ZES, hypersecretion can be controlled by high doses
of H2 receptor antagonists or sandostatin (suppresses
gastrin levels).
Stress reduction and rest : Biofeedback, hypnosis,
behavior modification, massage, etc.
Smoking Cessation, Diet modification
10. Vagotomy: Transects (severs) the vagus nerve that
stimulate acid secretion.
Anthrectomy: Removal of lower portion of the antrum
of the stomach along with some portion of duodenum
and pylorus. Duodenal segment anastomosis is done.
11. Pyloroplasty: Severs vagal innervation to stomach but
maintains to rest of abdominal organs. Denervates acid
secreting parietal cells but preserves vagal innervation
to gastric antrum. Longitudinal incision is taken into
the pylorus and transverse sutures are taken to enlarge
outlet and relax the muscles.
