2. OUTLINE
• Introduction
• Etiology/ Risk factors
• Types of PUD
• Clinical Presentation
• Pathophysiology
• Investigation/ Diagnostic test
• Complications of PUD
• Management
3. INTRODUCTION
• Peptic Ulcer is a lesion in the lining
(mucosa) of the digestive tract, typically
in the stomach or duodenum, caused by the
digestive action of pepsin and stomach
acid.
4. •Lesion may subsequently occur into the lamina propria
and submucosa to cause bleeding.
•Most of peptic ulcer occur either in the duodenum, or in
the stomach – Ulcer may also occur in the lower
esophagus due to reflexing of gastric content – Rarely in
certain areas of the small intestine
5. 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
EPIDEMIOLOGY
6. 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
7. ETIOLOGY
• Lifestyle
– Smoking
– Acidic drinks
– Medications
•
•
H. Pylori infection
– 90% have this bacterium
– Passed from person to
person (fecal-oral route
or oral-oral route)
Age
– Duodenal 30-40
– Gastric over 50
•
•
Gender
– Duodenal: are increasing
in older women
Genetic factors
Other factors: stress can
worsen but not the cause
8. RISK FACTORS
Alcoholic cirrhosis
Smoking or chewing
tobacco
Serious illness
Radiation treatment of
the area
H-pylori infection
NSAID’s
Psychological stress
Viral infections
12. • 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
SYMPTOMS
13. Perforations
Blotting and abdominal fullness
Nausea and vomiting
Loss of appetite (because of pain)
Weight loss
Stomach obstruction
Heartburn
Hematemesis
Melena
Deep tenderness
15. •Under normal conditions, a physiologic balance
exists between gastric acid secretion and
gastroduodenal mucosal defense.
•Mucosal injury and, thus, peptic ulcer occur
when the balance between the aggressive factors
and the defensive mechanisms is disrupted.
16. Aggressive factors, such as NSAIDs, H pylori
infection, alcohol, bile salts, acid, and pepsin, can
alter the mucosal defense by allowing back
diffusion of hydrogen ions and subsequent
epithelial cell injury
25. In all patients with “Alarming symptoms” endoscopy
is required.
Dysphagia.
Weight loss.
Vomiting.
Anorexia.
Hematemesis or Melena
26. Complications of Peptic Ulcers
Hemorrhage
– Blood vessels damaged as ulcer erodes into the muscles of stomach or
duodenal wall
Perforation
– An ulcer can erode through the entire wall
– Bacteria and partially digested food spill into
peritoneum =peritonitis
Narrowing and obstruction (pyloric)
– Swelling and scarring can cause obstruction of food leaving
stomach=repeated vomiting
27. MANAGEMENT
• LIFE STYLE MODIFICATION
• HYPOSECRETORY DRUG THERAPY
• H. pylori ERADICATION THERAPY
• SURGERY
30. Prostaglandin Analogs
– Reduce gastric acid and enhances mucosal resistance to
injury
– Misoprostol
Mucosal barrier fortifiers
– Forms a protective coat
• Carafate/Sucralfate
– cytoprotective
Antacids
• Neutralizes acid and prevents formation of pepsin
[Al(OH)3, Mg(OH)2] - (Maalox, Mylanta)
• Give 2 hours after meals and at bedtime
32. Indications:
Failure of medical treatment.
Development of complications
High level of gastric secretion and
combined duodenal and gastric ulcer.
Principle:
Reduce acid and pepsin
secretion.
33. Types of Surgical Procedures
GASTROENTEROSTOMY
Creates a passage between the body
of stomach to small intestines.
• Allows regurgitation of alkaline
duodenal contents into the
stomach.
