An eroded lesion in either the esophageal, gastric, or duodenal mucosare sulting fromt heaction of gastric secretions and typically H.pulori bacterial inflammation. For online medical resources visit at http://gisurgery.info

2. An eroded lesion in either the esophageal, gastric, or duodenal
mucosa resulting from the action of gastric secretions and typically
H.pulori bacterial inflammation.

3. • Normal gastric and duodenal mucosa is protected from the digestive
actions of acid and pepsin by the secretion of mucus, the production of
bicarbonate, the removal of excess acid by normal blood flow, and the
rapid renewal and repair of epithelial cell injury.
• Peptic ulcer refers to an ulcer that occurs as a result of the breakdown
of these normal defense and repair mechanisms.
• Typically more than one of the mechanisms must be malfunctioning
for symptomatic peptic ulcer to develop.
• Peptic ulcer typically show evidence of chronic inflammation and
repair processes surrounding the lesion.

4. Acid peptic ulcer may develop due to any of the following reasons.
• H.pylori infection.
• Increased number of parietal cell or acid secretion.
• Increased gastric emptying rates.
• Reduced ability of the duodenum to handle an acid load.
• Stress
• Excessive use of non steroidal anti inflammatory drugs (NSAID) and
corticosteroids.

5. • Increased gastric tone and painful hunger contraction when stomach
is empty.
•Piercing, burning and gnawing pain which usually relieved by taking
food.
• Frequent vomiting sometimes with blood too.
• Anorexia

6. • Gastrointestinal bleeding
• Intestinal perforation
•Peritonitis (inflammation of the lining of abdominal cavity)
• Anemia
• Intestinal narrowing and obstruction
• Shock

7. • Restoration of good nutritional status with dietary modifications
and counseling.
• Alleviate the symptoms.
• Neutralize acids.
• Reduce acid secretion.
• Preservation of epithelial resistance to the destructive action of
gastric juices.

8. • Milk neutralizes gastric acidity only for 20 to 60 minutes after its
ingestion and the PH reverts back to the basal levels. Current studies
indicate that a diet with high milk content has an adverse effect on the
healing rate of ulcer because of high calcium. So protein from cottage
cheese, egg, chicken and fish in adequate amounts is beneficial for
regeneration of cell. Additional protein 10-15g/day above the RDA can be
given.
• The products of fat digestion in the small intestine stimulate
entrogastrone, which inhibits gastric juice secretion. PUFA such as linoleic
and eicosapentanoic acid have been found to effective against duodenal
ulcer by inhibiting in vitro growth of H.Pylori. Around 25-30 g visible fat in
emulsified form can be given. Avoid fried foods as they cause digestive
problems.

9. • 55 to 65% of CHO can be given in simple and complex form but in
soft well cooked form. Soluble fiber is more beneficial than insoluble
as insoluble fiber delays gastric emptying time hence prevents the
mucosal damage by acidic gastric juice.
• Fruits in general are related to an alkaline ash diet. If they are not
well tolerated by some individuals, avoid them.
• Avoid taking alcohol, caffeine, black pepper ad meat extracts as
they significantly change gastric pH.
• Clinical observations have shown that tolerance for a variety of
standard foods is highly individual. Pulse, soyabean, cabbage,
cauliflower, onions, peas, apple, watermelon are some of the foods
identified.

10. • Cigarette smoking cause an adverse effect because of the presence of
nicotine which cause pyloric incompetence, increased reflux of
duodenal juice into the stomach, increased gastric acid secretion by
favoring gastric secretion, decrease pancreatic bicarbonate synthesis.

11. Stage 1
• Initially, for bleeding ulcer, if the patient is extremely nauseated or
vomiting he must be kept NBM
• This is followed by an hourly feeding to begin with milk and cream
100g/hr followed by small feeding of easily digestible food like soft
cooked eggs, custards, refined flour products, cottage cheese, low
fiber vegetables like gourds, clear soup with no seasoning and herbs,
soft over ripe fruit whips and light desserts.
• The diet must be feed orally and of liquid/semi liquid/ soft
consistency which is easy to digest

12. Stage 2
• Marked recovery from pain.
• 6 meal pattern followed.
• Light, blend, low fiber diet.
• Mechanical/ thermal, chemical irritation of gastric mucosa to be
avoided.
•Late night feeding avoided as the end products of digestion may
cause the epigastric pain.

13. Stage 3
• Number of feeds reduced to 3-4.
• Discharged from hospital – discharged diet
• Increased amount/ feed
Stage 4
• Liberalizing the diet depending on the patient’s individual
tolerance and schedule.
• Ensuring optimum intake of calorie, protein, fats, vitamins and
minerals.
•Relaxed atmosphere on eating.
• Lifestyle change.