Peptic Ulcer Disease Ppt April 2005


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Peptic Ulcer Disease Ppt April 2005

  1. 1. Peptic Ulcer Disease
  2. 2. Peptic Ulcer Disease <ul><li>Condition characterized by </li></ul><ul><ul><li>Erosion of GI mucosa resulting from the digestive action of HCl and pepsin </li></ul></ul><ul><ul><li>Any portion of GI tract that comes in contact with gastric secretions is susceptible to ulcer development including lower esophagus, stomach, & duodenum </li></ul></ul><ul><ul><li>Includes gastric and duodena l ulcers </li></ul></ul>
  3. 3. Types <ul><li>Acute </li></ul><ul><ul><li>Superficial erosion </li></ul></ul><ul><ul><li>Minimal inflammation </li></ul></ul><ul><ul><li>Resolves quickly when cause is identified & removed </li></ul></ul><ul><li>Chronic </li></ul><ul><ul><li>Muscular wall erosion with formation of fibrous tissue </li></ul></ul><ul><ul><li>Present continuously for many months or intermittently </li></ul></ul><ul><ul><li>4 times more common than acute ulcers </li></ul></ul>
  4. 4. Peptic Ulcers
  5. 5. Peptic Ulcer Disease Etiology and Pathophysiology <ul><li>Develop only in presence of acid environment </li></ul><ul><li>Excess of gastric acid not necessary for ulcer development </li></ul><ul><li>Person with a gastric ulcer has normal to less than normal gastric acidity compared with person with a duodenal ulcer </li></ul>
  6. 6. Peptic Ulcer Disease Etiology and Pathophysiology <ul><li>Some acid does seem to be essential for a gastric ulcer to occur </li></ul><ul><li>Under specific circumstances the mucosal barrier can be broken and HCL freely enters the mucosa & injury to tissues occurs </li></ul><ul><li>This results in cellular destruction & inflammation </li></ul><ul><li>Histamine is released </li></ul><ul><ul><li>Vasodilation, ↑ capillary permeability </li></ul></ul><ul><ul><li>Further secretion of acid and pepsin </li></ul></ul>
  7. 7. Peptic Ulcers <ul><li>Agents known to to destroy the mucosal barrier include: </li></ul><ul><li>H. Pylori - causes chronic inflammation making mucosa more vulnerable to noxious agents </li></ul><ul><li>drugs (aspirin, NSAIDs, corticosteroids) – cause abnormal permeability </li></ul>
  8. 8. Gastric Ulcers <ul><li>Commonly found on lesser curvature in close proximity to antral junction </li></ul><ul><li>Less common than duodenal ulcers </li></ul><ul><li>Prevalent in women, older adults, persons from lower socioeconomic class </li></ul>
  9. 9. Gastric Ulcers <ul><li>Characterized by a normal to low secretion of gastric acid </li></ul><ul><li>Back diffusion of acid is greater (chronic) </li></ul><ul><li>The ability of the gastric acid to penetrate the mucosal barrier is more important than the amount of gastric acid produced </li></ul>
  10. 10. Gastric Ulcers <ul><li>Critical pathologic process is amount of acid able to penetrate mucosal barrier </li></ul><ul><li>H. pylori is present in 50% to 70% </li></ul><ul><li>H. pylori is thought to be more destructive when noxious agents are used e.g.. drugs or smoking </li></ul>
  11. 11. Gastric Ulcers <ul><li>Drugs can cause acute and chronic gastric ulcers </li></ul><ul><ul><li>Aspirin, corticosteroids, and NSAIDs </li></ul></ul><ul><ul><li>Other known causative factors are: </li></ul></ul><ul><ul><ul><li>Chronic alcohol abuse, chronic gastritis </li></ul></ul></ul><ul><ul><ul><li>Cigarette smoking is positively linked with gastric ulcers </li></ul></ul></ul><ul><ul><ul><li>Ingestion of hot, spicy foods may be a cause but no evidence to support this </li></ul></ul></ul>
  12. 12. Duodenal Ulcers <ul><li>Occur at any age and in anyone </li></ul><ul><li>Incidence is high between ages of 35 to 45 years </li></ul><ul><li>Affect more men than women </li></ul><ul><li>Account for 80% of all peptic ulcers </li></ul>
  13. 13. Duodenal Ulcers <ul><li>Associated with ↑ HCl acid secretion </li></ul><ul><li>H. pylori is found in 90-95% of patients </li></ul><ul><ul><li>Direct relationship has not been proven </li></ul></ul>
  14. 14. Duodenal Ulcers <ul><li>Diseases with ↑ risk of duodenal ulcers - </li></ul><ul><ul><li>COPD, cirrhosis of liver, chronic pancreatitis, hyperparathyroidism, chronic renal failure </li></ul></ul><ul><li>Treatments used for these conditions may promote ulcer development </li></ul>
  15. 15. Duodenal Ulcer
  16. 16. Psychological Stress Ulcers <ul><li>Acute ulcers that develop following a major physiologic insult such as trauma or surgery </li></ul><ul><li>A form of erosive gastritis </li></ul>
  17. 17. Psychological Stress Ulcers <ul><li>Gastric mucosa of body of stomach undergoes a period of transient ischaemia in association with </li></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Severe injury </li></ul></ul><ul><ul><li>Extensive burns </li></ul></ul><ul><ul><li>Complicated surgery </li></ul></ul>
  18. 18. Peptic Ulcer Pain <ul><li>Gastric </li></ul><ul><li>Burning or gaseous </li></ul><ul><li>Can occur when stomach empty or immediately after food </li></ul><ul><li>Located high in epigastrium </li></ul><ul><li>Not necessarily relieved by food </li></ul><ul><li>Duodenal </li></ul><ul><li>Burning or cramp-like </li></ul><ul><li>Occurs 2-4 hrs after meals </li></ul><ul><li>Located in mid-epigastrium </li></ul><ul><li>Usually relieved by food or antacids </li></ul>
  19. 19. Peptic Ulcer Disease Complications <ul><li>3 major complications </li></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Perforation </li></ul></ul><ul><ul><li>Gastric outlet obstruction </li></ul></ul><ul><li>Initially treated conservatively </li></ul><ul><li>May require surgery at any time during course of therapy </li></ul>
  20. 20. Peptic Ulcer Disease Hemorrhage <ul><li>Most common complication of peptic ulcer disease </li></ul><ul><li>Develops from erosion of </li></ul><ul><ul><li>Granulation tissue found at base of ulcer during healing </li></ul></ul><ul><ul><li>Ulcer through a major blood vessel </li></ul></ul>
  21. 21. Peptic Ulcer Disease Perforation <ul><li>Most lethal complication of peptic ulcer </li></ul><ul><li>Commonly seen in large penetrating duodenal ulcers that have not healed and are located on posterior mucosal wall </li></ul><ul><li>Perforated gastric ulcers often located on lesser curvature of stomach </li></ul>
  22. 22. Peptic Ulcer Disease Perforation Fig. 40-15