this presentation for medical students

1. PROBLEM 1
GASTRITIS & PUD
Presented by
Class 3
2013
SCU – FOM

3. MANAGEMENT
The patient received many
medications( ranitidine, famotidine &
omeprazole) without completely
relieve of symptoms.
so
Dr requested for upper
gastroenterology endoscopy with
diagnosis of pre-pyloric area .

4. FINDINGS
* A pre-pylric area with active edge and granulation tissue in
its base
* another 2 small ulcers in the duodenal bulb .
so:
a prescription of TTT for 2 weeks with relieve of symptoms
for about 1 year .
But:
The symptoms recurred again
in the emergency department:
The patient was resuscitated by blood transfusion &
prepared upper GIT endoscopy.

5. A large gastric ulcers and diffuse hyperemic mucosa in antrum and
prepyloric area.
.

6. WHERE IS OUR STOMACH????

7. STOMACH…

8. HISTOLOGY OF STOMACH

9. PHYSIOLOGY OF STOMACH

11. H.PYLORI

12. PATHOGENESIS OF H.PYLORI GASTRITIS

14. CLASSIFICATION OF GASTRITIS
 Acute gastritis:
1. Hemorrhagic/erosive gastritis
2. Phlegmonous gastritis
3. Acute H. pylori gastritis
 Chronic gastritis:
1. H. pylori gastritis
2. Autoimmune gastritis
3. Chemical gastritis (Reactive gastropathy)
4. Granulomatous gastritis
5. Eosinophilic gastritis
6. Lymphocytic gastritis
7. Graft versus host disease.

15. CHRONIC GASTRITIS (ABC)-
CLASSIFICATION
A – Autoimmune
B – Bacterial (helicobacter)
C - Chemical

16. MORPHOLOGY OF CHRONIC GASTRITIS
Chronic inflammatory
cell infiltration
Glandular
atrophy
Intestinal (goblet cell)
metaplasia)

17. PUD-ETIOLOGY:
 Helicobacter pylori infection.
 Hyperacidity - eg. Zollinger Ellison.
 Drugs - anti-inflammatory (NSAIDs) &
Corticostroids.
 Cigarette smoking,
 Alcohol,
 Rapid gastric emptying ,
 Personality and stress.

18. PUD- CLINICAL FEATURES
 Gastric Ulcer:
- Usual age beyond 6th decade
- More often in labouring persons
- Food-pain pattern (occur 2 hours after food ingestion), no
night pain
- Significant loss of weight
- Loss of appetite, patients choose bland diet (as milk, egg)
devoid of fried foods, spicy foods
- Vomiting common
- Haematemesis more common than melena
- Deep tenderness in the midline of epigastrium .

19. PUD- CLINICAL FEATURES
 Duodenal Ulcer;
- Usual age 25-50 years
- More in people faced more stress and strain of life (e.g.,
leaders)
- Attacks are classically worsened by ‘work, worry, and weather’
- Hunger-pain; pain at night and is relieved by food ingestion
(pain-food-relief pattern)
- Patients have a very good appetite, take all kinds of diets
- Patients tend to gain weight
- Patients rarely have vomiting but instead get heart burn, and
water brash
- Melaena more common than haematemesis
- Deep tenderness in the right hypochondrium.

20. MANAGEMENT…

21. RANITIDINE

22. FAMOTIDINE

23. OMEPRAZOLE

24. ANTACID

25. CLARITHROMYCIN

26. FDA-Approved Treatment Regimes
for H. pylori Infection
Omeprazole 20 mg BID +
Clarithromycin 500 mg BID + Amoxicillin
1 g BID for 10 days
***************************************
Lansoprazole 30 mg BID
+Clarithromycin 500 mg BID +
Amoxicillin for 10 days
***************************************
Bismuth subsalicylate + Metronidazole
+ Tetracycline for 14 days + H2 receptor
antagonist for 4 wks

27. MCQS

30. ‫هللا‬ ‫رسول‬ ‫قال‬(‫صلي‬
‫سلم‬ ‫و‬ ‫عليه‬ ‫هللا‬:)
”‫و‬ ‫الداء‬ ‫بيت‬ ‫المعدة‬
‫دواء‬ ‫خير‬ ‫الحمية‬“
‫هللا‬ ‫رسول‬ ‫صدق‬(‫صل‬‫ي‬
‫سلم‬ ‫و‬ ‫عليه‬ ‫هللا‬)

32. Mohamed ElRashidy
Soliman Magdi
Mohamed Gomaa
Yasmin Gharib Amany
Saad
Nashwa Zakaria
Fatma Ahmed