Peptic ulcer disease includes gastric, esophageal, and duodenal ulcers, with complications such as perforation, bleeding, and obstruction. The incidence of elective surgeries for peptic ulcers has decreased significantly, with internal bleeding being a common complication. Risk factors include NSAID use, age, and genetic predisposition, and symptoms of complications can include sharp pain, black stools, and vomiting.

1. COMPLICATIONS OF PEPTIC ULCER DISEASE
DONE BY : MUSTAFA KHALIL IBRAHIM
TBILISI STATE MEDICAL UNIVERSITY
4th year, 1st semester, 2nd group

2. ANATOMY & PHYSIOLOGY

3. PEPTIC ULCER
 Peptic ulcers are open sores
include :
 Gastric ulcers
 Esophageal ulcers
 Duodenal ulcers

4. MORBIDITY
100
30
1 2
Surgical Treatment Before and After PPI (%)
The number of elective operations for peptic ulcer disease
dropped more than 70% in the 1980s;
80% of these procedures were emergent operations

5. CAUSES
 H. pylori infections are now uncommon.
 (NSAIDs).
 Smoking, alcohol.
 Mental stress.
 Genetics.
 This is because these types of ulcers do not
always cause obvious symptoms, so are left
untreated.
 It is estimated that around 1 in 50 people with
a NSAID-related stomach ulcer will develop a
complication.

6. SYMPTOMS OF COMPLICATED PUD
sudden, sharp pain that doesn’t stop
black or bloody stools
bloody vomitus
vomit that looks like coffee grounds

7. COMPLICATIONS OF PUD
1. Perforation
2. Bleeding
3. Penetration
4. Maliginization
5. Obstruction

8. PEPTIC ULCER PERFORATION
 It affects around 1 in 350 people with a stomach ulcer.
 Annual incidence of ulcer perforation is 4 to 14 cases per 100,000
individuals
Pneumoperitoneum

9. SURGICAL TREATMENT OF PERFORATION

10. VAGOTOMY

11. BLEEDING FROM PEPTIC ULCER
 Melena
 Tachycardia
 Hypotension
Main possible reasons:
 Peptic ulcer;
 Gastritis;
 Portal hypertension
Stops spontaneously in 75%.
Reminder will require surgery or
die;

12. BLEEDING FROM PEPTIC ULCER
 Peptic ulcer hemorrhage is on the order
of 19 to 57 cases per 100,000 individuals
 Internal bleeding is the most common
complication of stomach ulcers. Internal
bleeding can occur when an ulcer
develops at a site of a blood vessel. You
are at an increased risk of bleeding if
you:
 are on continued use of non-steroidal
anti-inflammatory drugs (NSAIDs)
 are 60 years old or over

13. PENETRATION OF PEPTIC ULCER

14. MALIGNIZATION OF PEPTIC ULCER

15. GASTROECTOMY

16. OBSTRUCTION BY PEPTIC ULCER
Symptoms:
• Vomiting – Usually right after eating,
yellow or green. contains foods eaten more
than 12 hours earlier.
• Epigastric pain
• Constipation
• Loss of weight
• Hypokalemia and metabolic acidosis –
Due to vomiting.
• Hypertrophy of stomach muscles

17. PEPTIC ULCER SURGICAL COMPLICATIONS
 A. Early complications
 Duodenal stump leakage;
 Hemorrhage
 B. Late complications
 Recurrent ulcer
 Gastrojejunocolic and gastrocolic fistula
 Dumping syndrome (cardio-vascular and gastro-intestinal
symptoms). Shortly after eating palpitations, sweating,
weakness, flushing, nausea, vomiting, diarrhea etc.
 Anemia: iron deficiency anemia develops in 30% within 5 years
after gastrectomy;
 Postvagotomy diarrhea.
 Chronic gastroparesis

18. REFERENCES
 http://www.mayoclinic.org/diseases-conditions/peptic-
ulcer/basics/treatment/con-20028643
 Current Surgical Diagnosis and Treatment. A Lange Medical
Book. 12th edition, Edited by G. Doherty and L. Way. 2006.
pp:508-538.
 https://www.google.ge/search?q=Penetration+of+Peptic+Ulcer&so
urce=lnms&tbm=isch&sa=X&ved=0ahUKEwim75eNmbrNAhWCj
ywKHYG9AKsQ_AUICCgB&biw=1366&bih=599#tbm=isch&q=pe
ptic+ulcer+&imgdii=Zs1jluqdcC6e6M%3A%3BZs1jluqdcC6e6M%
3A%3BkT0uGJniXot5TM%3A&imgrc=Zs1jluqdcC6e6M%3A

21.  Lansoprazole
 Amoxicillin
 Claritromycin
 H2 receptor antagonists
 Proton pump blockers
 Antacids