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peptic_ulcer12102021.ppt
- 1. PRESENTED BY : DRDEEPTI DEWAN PG Scholar UNDER THE GUIDANCE OF : DR ANUPAMA DEPARTMENT OF CASE TAKING & REPERTORY GOVERNMENT HOMOEOPATHIC COLLEGE & HOSPITAL BENGALURU, KARNATAKA
- 2. APD= Acid PepticDisease Peptic Ulcer Gastric Ulcer Duodenal Ulcer Hyperacidity ZE Syndrome GERD
- 3. APD= Acid Peptic Disease AcuteUlcer Stress Ulcer Curling’s Ulcer Cushing’s Ulcer
- 4.
- 5. Peptic Ulcer Approximately onecase per 1000 person-years in the general population, and the incidence of ulcer complications was approximately 0.7 cases per 1000 person-years Reference : Peptic ulcer disease: Epidemiology, etiology, and pathogenesis. Available at : https://www.uptodate.com/contents/peptic-ulcer-disease-epidemiology-etiology-and- pathogenesis#PATIENT_INFORMATION
- 7. Duodenal Ulcer Proximal duodenum 1- 2 cm of pylorus ▲ acid Distal duodenum = Zollinger– Ellison syndrome
- 8. Type 1 GastricUlcer most common (among gastric Ulcers) proximal antrum mucosal defense acid
- 9. Type II GastricUlcer Secondary to DU + pyloric stenosis
- 10. Type III GastricUlcer Prepyloric and pyloric canal ulcer acid ▲ common etiology with DU
- 11.
- 12.
- 13. Pathogenesis Imbalance of acid-pepsin andmucosal defence H. pylori infection NSAID ZE Syndrome Type A personality
- 14. H.pylori 95% - duodenalulcer 80% - gastric ulcer mucosal resistance hydrophobicity eradication reduces ulcer recurrence
- 15. NSAID Suppress prostaglandins prostaglandin ► acid secretion ▲ mucosal blood flow mucus & bicarbonate secretion 10 -30% in chronic users
- 16. ZE= Zollinger EllisonSyndrome Recurrent Recalcitrant Resistant Unusual sites Multiple Malignant
- 17. ZE Syndrome 0.1 -1.0% of peptic ulcer Type I and Type II Gastrin secretion from non-beta cell tumor of pancreas - Gastrinoma MC in pancreas ; duodenum, antrum
- 18. ZE Syndrome 20% multiple 66%malignant slow growing indolent tumor parietal cell mass increased genetic basis massive hyper-secretion of acid
- 19. ZE Syndrome MEN -I – hyperparathyroidism – islet cell tumor – pituitary tumors
- 20. A/ DU NSAIDs Acid hypersecretion Rapidgastric emptying Impaired acid disposal Smoking
- 21. Duodenal Ulcer Increased secretionof acid More rapid gastric emptying Decreased prostaglandin Chronic duodenitis with H.pylori Smoking
- 22. Gastric Ulcer H.pylori NSAIDs Duodenogastric reflux Impairedgastric mucosal defense
- 23. Gastric Ulcer Acid secretion- normal to low Reflux of duodenal contents gastritis ulcer Pylorus sphincter disorder Smoking Disturbed mucosa with low grade gastritis
- 24.
- 25. CP Duodenal Ulcer – painrelieved by food or alkali – pain several hours after meal Gastric Ulcer - gnawing or burning pain on eating
- 26. Clinical Presentation Periodic chronicrecurrent pain Nausea & vomiting Weight loss Epigastric tenderness
- 27.
- 28. Investigations Endoscopy – 90% sensitivity –must in all pts. with severe pain – excludes malignancy – biopsy can be taken – test for H.pylori
- 29. Investigations Barium Meal double(air) contrast – 90% sensitivity
- 30. H Pylori detection: Breathtest Blood test Tissue test
- 31.
- 32. Differential Diagnosis Cholecystitis Hiatus hernia Pancreatitis MI Pneumonia Dissectinganeurysm Worm Infestations
- 33.
- 36. Treatment Stop smoking, NSAIDs Stopalcohol Antacids - acid neutralisation H2 receptor antagonist - Ranitidine- secretion inhibition
- 37. Rx- Medical H+ pumpinhibition - H+/K+ase inhibition - Omeprazole Anticholinergic - secretory inhibition Prostaglandin - Misoprostol - mucosal protection
- 38. Hemorrhage Hemorrhage - potentialcause of death 15 -20% gross bleeding erosion of duodenal ulcer into gastro-duodenal artery Endoscopy –laser, sclerosant oralcohal injection
- 39. Perforation In 5-10% ofcases pneumo-peritoneum in 75% cases peritonitis, pain, ileus leukocytosis, hypovolumia, IIIrd space loss DD - acute appendicitis, enteric perf.
- 40. Obstruction Chronic ulcer diseasewith edema and scarring in 5% cases of DU nausea, vomiting, abdominal distension metabolic alkalosis, paradoxical aciduria
- 41.
- 42. Homoeopathic Management Acute Medicines– To Manage acute episodic symptoms Constitutional medicines can be prescribed for cure
- 43.