Complications of gastric ulcer and duodenal ulcer (bleeding). Gastrointestinal bleeding (Mallory-Weiss syndrome, Varicose veins of the esophagus, complicated

1. GASTRIC AND DUODENAL ULCER
COMPLICATIONS OF GASTRIC ULCER AND
DUODENAL ULCER (BLEEDING).
GASTROINTESTINAL BLEEDING (MALLORY-
WEISS SYNDROME, VARICOSE VEINS OF THE
ESOPHAGUS, COMPLICATED BY BLEEDING)
ARYAN KHATRI
GM20-120

2. CONTENTS
• Brief description
• Pathogenesis
• Causes
• Symptoms
• Complications
• Diagnostic plan
• Treatment
• Prevention
• Case Study

3. BRIEF DESCRIPTION
• Gastric and duodenal ulcers are open sores that develop in
the lining of the stomach (gastric ulcer) or the first part of the
small intestine, the duodenum (duodenal ulcer). These ulcers
can lead to various symptoms and complications.

4. PATHOGENESIS
• The primary cause of gastric and duodenal ulcers is the
imbalance between protective and aggressive factors in the
stomach and duodenal mucosa. Factors contributing to ulcer
formation include infection with Helicobacter pylori bacteria,
prolonged use of nonsteroidal anti-inflammatory drugs
(NSAIDs), and increased gastric acid production.

5. CAUSES
1. Helicobacter pylori Infection: Bacterial infection in the stomach lining.
2. NSAID Use: Prolonged use of nonsteroidal anti-inflammatory drugs.
3. Smoking: Increased risk for ulcer development.
4. Stress: Though not a direct cause, stress may exacerbate symptoms.

6. SYMPTOMS
1. Burning or Gnawing Pain: Typically in the upper abdomen.
2. Nausea and Vomiting: Especially after meals.
3. Loss of Appetite: Aversion to food due to pain.
4. Weight Loss: Unintentional weight loss in severe cases.

7. COMPLICATIONS
1. Bleeding Ulcer: Resulting in melena or hematemesis.
2. Perforation: Ulcer penetration through the stomach or duodenal wall.
3. Gastric Outlet Obstruction: Narrowing of the outlet due to scarring.
Most Affected Groups of People: Gastric and duodenal ulcers can affect individuals of any age
but are more common in adults. Risk factors include H. pylori infection, NSAID use, smoking, and
a history of ulcers.

8. DIAGNOSTIC PLAN
1. Upper Endoscopy (Esophagogastroduodenoscopy, EGD): Direct visualization of the
stomach and duodenum for ulcer detection.
2. Biopsy: To test for H. pylori infection.
3. Blood Tests: Detecting H. pylori antibodies.
4. Barium Contrast X-ray: Highlighting ulcer features.

9. TREATMENT
1. Eradication of H. pylori: Antibiotics, proton pump inhibitors (PPIs), and other
medications.
2. PPIs or H2 Blockers: To reduce gastric acid production.
3. Antacids: Symptomatic relief and neutralization of acid.
4. Avoidance of NSAIDs and Smoking: Lifestyle modifications.
5. Endoscopic Therapy: For bleeding ulcers or complications.
6. Surgery: In cases of severe bleeding, perforation, or obstruction.

10. PREVENTION
1. Avoid NSAID Overuse: Use these medications cautiously and under medical supervision.
2. H. pylori Eradication: Particularly in those with a history of ulcers.
3. Quit Smoking: Smoking cessation reduces the risk of ulcers.

11. MALLORY-WEISS SYNDROME
• Mallory-Weiss syndrome is one of the common causes of acute upper gastrointestinal bleeding and is
characterized by the presence of longitudinal superficial mucosal lacerations (Mallory-Weiss tears).
These tears occur primarily at the gastroesophageal junction and may extend proximally to involve the
lower to mid-esophagus or distally to involve the proximal portion of the stomach. This activity reviews
the etiology, pathogenesis, evaluation, and management of Mallory-Weiss syndrome and highlights the
role of the interprofessional team in evaluating and treating patients with this condition.

12. MALLORY-WEISS SYNDROME
• Etiology
• Heavy alcohol ingestion is considered to be one of the most important predisposing factors as about 50%
to 70% of the patients diagnosed with Mallory-Weiss syndrome have a history of the same.The severity
of the upper GI bleeding with Mallory-Weiss syndrome is also reported to be higher with the concurrent
presence of portal hypertension as well as esophageal varices.
• The relationship between a hiatal hernia (protrusion of an organ, usually the upper part of the stomach
into the chest cavity through the esophageal opening of the diaphragm) and Mallory-Weiss syndrome is
still a matter of debate. A hiatal hernia was found in a considerable number of cases with Mallory-Weiss
syndrome, while a case-control study conducted at the Mayo Clinic in Florida found no difference in the
incidence of a hiatal hernia between patients with Mallory-Weiss syndrome and the control group.

13. MALLORY-WEISS SYNDROME
• Pathophysiology
• The exact mechanism by which Mallory-Weiss tears occur is still unknown. The suggested theory is that
when the intraabdominal pressure suddenly and severely increases (as in cases of forceful retching and
vomiting), the gastric contents rush proximally under pressure into the esophagus. This excess pressure
from the gastric contents results in longitudinal mucosal tears which may reach deep into the submucosal
arteries and veins, resulting in upper GI bleeding. These tears tend to be longitudinal, and not
circumferential, possibly because of the cylindrical shape of the esophagus and stomach.

14. VARICOSE VEINS OF ESOPHAGUS
• Esophageal varices are enlarged veins in the lining of your esophagus, the swallowing tube
that connects your mouth to your stomach. Varices are serious because they have weakened
walls that can leak or break and bleed. Internal bleeding from a ruptured vein can be sudden,
severe and life-threatening.
• Esophageal varices occur in people with portal hypertension which is high blood pressure in
the portal vein that runs through your liver and the other veins that branch off from it. Abnormal
pressure causes the thin esophageal veins to swell and enlarge. This most often occurs in
people with liver disease

15. VARICOSE VEINS OF ESOPHAGUS
• Esophageal varices aren’t visible from the outside like varicose veins in your leg might be.
They’re deep inside your chest cavity, usually close to the bottom, where your esophagus
meets your stomach. You’re not likely to feel them when you swallow. They usually don’t cause
symptoms at all until they bleed.
• A healthcare provider might suspect that you have esophageal varices if they see other signs
suggesting portal hypertension or chronic liver disease. These might include:
• Jaundice a yellowing of your skin and eyes.
• Ascites, a buildup of fluid in your abdomen.
• Edema, swollen legs and feet.
• Upper abdominal pain
• Itching(pruritus), with no visible rash.
• Confusion or disorientation (hepatic encephalopathy).

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