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Peptic ulcer disease

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Mansi Sanghvi
Mansi Sanghvi

Peptic ulcer disease involves breaks in the mucosal lining of the stomach or duodenum that penetrate through the muscular layer. The most common causes are infection with H. pylori bacteria and use of non-steroidal anti-inflammatory drugs (NSAIDs). Symptoms include abdominal pain, nausea, and weight loss. Diagnosis involves endoscopy to visualize the ulcers. Treatment involves antibiotics to eradicate H. pylori, proton pump inhibitors to reduce acid secretion, and avoidance of NSAIDs. Surgery is reserved for complications or treatment failure.

Health & Medicine
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PEPTIC ULCER DISEASE --Dr. Mansi
What is PEPTIC ULCER????? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SITES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathomorphology ,[object Object],[object Object],[object Object],Margins – Perpendicular - No Elevatn or Beading Mild oedema of immediate adj. mucosa Surrounding Mucosal folds Radiate like Wheel Spokes Base Remarkably Clean
Duodenal ulcer Gastric ulcer Patho physiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],increasd decreased rapid delayed Bicarbonate secretion remarkably decreased H.pylori & NSAID H.pylori & NSAID Abnormal resting & stimulated Pyloric sphincter pressure
ETIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pathogenetic factors not related to h.pylori & NSAID
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],H.pylori
Cytokines-IL 1 α / β , IL6,IL2, IL8(recruits act. neutrophils) TNF- α ,IFN- γ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cagA into host cells ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],V I R U L E N C E Pathophysiology of H.pylori ulcer
[object Object],[object Object],[object Object],Then how does it cause Ulcers in duodenum?????
[object Object],[object Object],Direct toxicity by Ion trapping ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ULCER erosions Healing (spontaneous Or therapeutic) NSAID induced PUD Pathophysiology Epithelial effects Due to PG depletion
Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Symptom : sudden continuous generalized abd pain Examn : severly tender board like abdomen Common in elderly and with NSAID Penetration Complications Symptoms : Pain worsening with meals, nausea and vomiting of undigested food Examn : succusion splash Symptoms : Tarry stools or coffee ground emesis Acute hematemesis Anemia Examn : tachycardia and orthostasis suggesting dehydration
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Differential diagnosis
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Evaluation
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Non invasive: serology Urea breath test Stool antigen Invasive : rapid urease histology culture Duodenal ulcer Gastric ulcer
Treatment
[object Object],[object Object],[object Object],[object Object],: Magnesium Hydroxide ,Aluminum Hydroxide , Sodium Bicarbonate , Calcium Carbonate :100 – 150 meq/l 1 & 3 hrs after the meal & hs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],-Sucralfate – 1gm qid -Misoprostol - 200 μ g qid
Regimens for Eradication Of H.Pylori ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Regimens for Eradication Of H.Pylori 3. Omeprazole + - 20mg bid Claithromycin + -250/500mg bid Metronidazole / -500mg bid Amoxicillin - 1gm bid
[object Object],[object Object],[object Object],[object Object]
Surgical Therapy ,[object Object],[object Object],[object Object],[object Object]
Surgical Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
THANK YOU

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Peptic ulcer disease

Editor's Notes

  1. DU1 st part within 3 cm of pylorus GU occasionally it can be on greater curvature or ant and post walls
  2. Duodenum—smaller<1 cm but there also occasionally 3 to 6 cm large Occasionally gastric ulcers are larger than this
  3. Ill defined, aching sensation or as hunger pain