1. Peptic Ulcer
Hawler Medical University
College of Medicine
Community Health
Prepared by:
Hawraz Faris Saadi
BSN, MD Student
11/30/2017 1
2. Peptic Ulcer
Is a break in the lining of the stomach , first part
of the small intestine or occasionally the lower
esophagus.
Peptic ulcers are produced by an imbalance
between the gastroduodenal mucosal defense
mechanisms and damaging forces of gastric acid
and pepsin, combined with superimposed injury
from environmental or immunologic agents
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3. Peptic Ulcer Cont.
Contrary to general belief, more peptic ulcers
arise in the duodenum than in the gastric, four
times more common than gastric ulcers
Duodenal ulcers usually first occur between the
ages of 30-50 years and are twice as common in
men as in women.
Gastric ulcers usually occur in people older than
60 years and are more common in women.
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6. Symptoms
Duodenal ulcer
burning, aching, or hunger-like pain, primarily in the
upper middle region of the abdomen below the
breastbone (the epigastric region).
Pain may occur or worsen when the stomach is empty,
usually two to five hours after a meal.
Symptoms may occur at night between 11 PM and 2 AM,
when acid secretion tends to be greatest.
Feel better when you eat or drink and then worse 1 or 2
hours later (duodenal ulcer)
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7. Symptoms Cont.
Gastric ulcer
pain soon after eating.
Symptoms are sometimes not relieved by eating or
taking antacids.
Feel worse when you eat or drink.
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8. Causes
Peptic ulcers occur when acid in the digestive
tract eats away at the inner surface of the
stomach or small intestine or backward to the
esophagus.
The acid can create a painful open sore that may
bleed.
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10. Causes Cont.
1. A bacterium. Helicobacter pylori bacteria
commonly live in the mucous layer that covers
and protects tissues that line the stomach and
small intestine. Often, the H. pylori bacterium
causes no problems, but it can cause
inflammation of the stomach's inner layer,
producing an ulcer.
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11. Causes Cont.
1. A bacterium:
It's not clear how H. pylori infection spreads.
It may be transmitted from person to person by close
contact, such as kissing.
People may also contract H. pylori through food and
water.
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12. Causes Cont.
2. Regular use of certain pain relievers. NSAIDs
inhibit production of an enzyme
(cyclooxygenase) that produces prostaglandins.
These hormone-like substances help protect
stomach lining from chemical and physical injury.
Without this protection, stomach acid can erode
the lining, causing bleeding and ulcers
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13. Risk factors
1. Smoke. Smoking may increase the risk of peptic
ulcers in people who are infected with H. pylori.
Increased rate of gastric emptying
Diminished pancreatic bicarbonate secretion
Decreased duodenal pH
Reduced mucosal blood flow
Inhibition of mucosal prostaglandins
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14. Risk factors
2. Drink alcohol. Alcohol can irritate and erode the
mucous lining of the stomach, and it increases
the amount of stomach acid that's produced.
3. Have untreated stress.
4. Eat spicy foods.
5. Caffeine.
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15. Test and diagnosis
1. Noninvasive
a) Urea Breath Test (UBT)
b) Blood test
2. Invasive
a) Histology
b) Biopsy Urease Test
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16. Complications
1. Internal bleeding. Bleeding can occur as slow
blood loss that leads to anemia or as severe
blood loss that may require hospitalization or a
blood transfusion. Severe blood loss may cause
black or bloody vomit or black or bloody stools.
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17. Complications Cont.
2. Infection. Peptic ulcers can eat a hole through
(perforate) the wall of your stomach or small
intestine, putting you at risk of serious infection
of your abdominal cavity (peritonitis).
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18. Complications Cont.
3. Obstruction. Peptic ulcers can lead to swelling,
inflammation or scarring that may block passage
of food through the digestive tract. A blockage
may make you become full easily, vomit and lose
weight.
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19. Goals of treatment
1. Lowering the amount of acid that stomach makes,
2. Neutralizing the acid
3. Protecting the injured area so it can heal
4. It's also very important to stop smoking and drinking
alcohol
5. Prevent complications (bleeding, perforation,
penetration, obstruction)
6. Minimize recurrences
7. Reduce financial costs
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21. Primary prevention
1. Health education about the diseases, causes, risk
factors, and how prevent it.
2. Avoid tobacco products.
3. Avoid alcohol.
4. Use caution with aspirin and/or NSAIDs.
5. Protect yourself from infections by washing
hands regularly and consuming foods that have
been cooked thoroughly
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22. Secondary prevention
1. Screening and early diagnosis is very important to
treating and prevent complications.
2. While avoidance of nonsteroidal anti-inflammatory
drugs (NSAIDs) and cigarette smoking may decrease
the risk of recurrence, the role of alcohol intake is
less certain.
3. Nonetheless, avoidance of excessive alcohol intake is
usually recommended
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