Rohal.peptic ulcer

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Rohal.peptic ulcer

  1. 1. "Each time you are honest and conduct yourself with honesty, a success force will drive you toward greater success. Each time you lie, even with a little white lie, there are strong forces pushing you toward failure." alee
  2. 2. Pathology of Peptic Ulcer By ali aziz
  3. 3. Normal Stomach
  4. 4. Esophagus & Stomach Normal
  5. 5. Definition: <ul><li>Ulceration (breach in mucosa) due to acid & pepsin attack – peptic ulcer. </li></ul><ul><li>Deeper than just mucosa </li></ul><ul><li>Single, punched out, clean base – why? </li></ul>
  6. 6. Etiology: (study of causes) <ul><li>Helicobacter pylori infection.(bacteria) </li></ul><ul><li>Hyperacidity – </li></ul><ul><li>Drugs - anti-inflammatory (NSAIDs) & Corticostroids. </li></ul><ul><li>Cigarette smoking, Alcohol, </li></ul><ul><li>Rapid gastric emptying </li></ul><ul><li>Personality and stress </li></ul>
  7. 7. H. Pylori organisms- silver st.
  8. 8. Pathogenesis: : (process) <ul><li>Helicobacter pylori infection </li></ul><ul><li>Colonization of gastric mucous </li></ul><ul><li>Urease  ammonia  neutralization of acid  Rebound acid production. </li></ul><ul><li>Protease – Mucous break down. </li></ul><ul><li>Weak mucosal resistance </li></ul><ul><li>Acid & Pepsin digestion of mucosa </li></ul><ul><li>Chronic Ulceration </li></ul>
  9. 9. Etiology of PUD Normal Increased Attack Hyperacidity Weak defense Helicobacter pylori * Stress, drugs, smoking
  10. 10. Helicobacter pylori: <ul><li>Most common infection in the world (20%) </li></ul><ul><li>10% of men, 4% women develop PUD * </li></ul><ul><li>Positive in 70-100% of PUD patients. </li></ul><ul><li>H.pylori related disorders: </li></ul><ul><ul><li>Chronic gastritis – 90% </li></ul></ul><ul><ul><li>Peptic ulcer disease – 95-100% </li></ul></ul><ul><ul><li>Gastric carcinoma – 70% </li></ul></ul><ul><ul><li>Gastric lymphoma </li></ul></ul><ul><ul><li>Reflux Oesophagitis. </li></ul></ul><ul><ul><li>Non ulcer dyspepsia </li></ul></ul>
  11. 11. Peptic Ulcer Morphology: <ul><li>90% ulcers in first portion of duodenum or lesser curvature of stomach(4:1). </li></ul><ul><li>80 to 90% cases single ulcer. Round Small ulcers with sharply punched out edges* </li></ul><ul><li>Small <2cm, clean base*. </li></ul><ul><li>Microscopy: 4 zones. </li></ul><ul><ul><li>Superficial necrotic layer. </li></ul></ul><ul><ul><li>Inflammatory cells zone. </li></ul></ul><ul><ul><li>Granulation tissue zone </li></ul></ul><ul><ul><li>Collagenous scar layer. </li></ul></ul>
  12. 12. Complications: <ul><li>Bleeding – Chronic-IDA, Acute, Massive </li></ul><ul><li>Fibrosis, Stricture obstruction – pyloric stenosis. </li></ul><ul><li>Perforation – Peritonitis- emergency. </li></ul><ul><li>Gastric carcinoma. (not duodenal ca) </li></ul>
  13. 13. Acute Esophagitis & Gastritis
  14. 14. Gastric peptic ulcer:
  15. 15. Gastric peptic ulcer:
  16. 16. Gastric Ulcer
  17. 17. Duodenal Peptic Ulcer
  18. 18. Gastric Ulcer
  19. 19. Peptic ulcer - Endoscopy
  20. 20. Gastric Ulcer
  21. 21. Gastric Ulcer
  22. 22. Gastric Ulcer <ul><li>Punched out ulcer </li></ul><ul><li>Clean base </li></ul><ul><li>Small single </li></ul><ul><li>Radiating mucosal folds. </li></ul><ul><li>Benign ulcer. </li></ul><ul><li>No tumor. </li></ul>
  23. 23. Peptic Ulcer
  24. 24. Peptic Ulcer Microscopy:
  25. 25. Perforation:
  26. 26. Acute Esophagitis & Gastritis
  27. 27. Fungating
  28. 28. Linitis Plastica – Schirrhous Carcinoma.
  29. 29. Helecobacter pylori <ul><li>Gram negative, Spiral bacilli </li></ul><ul><li>Spirochetes </li></ul><ul><li>Do not invade cells – only mucous </li></ul><ul><li>Breakdown urea - ammonia </li></ul><ul><li>Break down mucosal defense </li></ul><ul><li>Chronic Superficial inflammation </li></ul>
  30. 30. PUD - Diagnosis <ul><li>Endoscopy </li></ul><ul><li>Barium meal – contrast x-ray </li></ul><ul><li>Biopsy – bacteria & malignancy </li></ul><ul><li>H.Pylori: </li></ul><ul><ul><li>Endoscopy cytology </li></ul></ul><ul><ul><li>Biopsy – Special stains </li></ul></ul><ul><ul><li>Culture - difficult </li></ul></ul><ul><ul><li>Urease Breath test. </li></ul></ul>
  31. 31. Points to Remember: <ul><li>A peptic ulcer is a sore in the lining of the stomach or duodenum due to attack by acid & Pepsin. </li></ul><ul><li>The major cause - H. pylori bacterium. Others are NSAIDs. spicy food, stress are risk factors. </li></ul><ul><li>H. pylori can be transmitted from person to person through close contact </li></ul><ul><li>A combination of antibiotics and H pump inhibitors is the most effective treatment. </li></ul>
  32. 32. Helecobacter pylori
  33. 33. “ You get ulcer, not from what you eat, but from what’s eating you..!”

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