Peptic Ulcer Disease is caused by stomach acid and pepsin damaging the stomach or duodenal lining. Risk factors include H. pylori infection, smoking, NSAIDs, and age. The two main types are gastric and duodenal ulcers. Patients may experience abdominal pain or bleeding. Diagnosis involves endoscopy, biopsy, and breath testing. Treatment focuses on eradicating H. pylori, reducing acid with PPIs or H2 blockers, and surgery for complications. Lifestyle changes and multi-drug antibiotic regimens are effective at curing ulcers and preventing recurrence.
This topic helps you , how to approach a patient having peptic ulcer disease and how to diagnose finally how to end up with treatment. Peptic ulcer disease a chronic disease of stomach and duodenum where the protective layer of stomach and duodenum weakens by many factors most common is H Pylori infection. Infection of H Pylori cause ulcer over time.
This topic helps you , how to approach a patient having peptic ulcer disease and how to diagnose finally how to end up with treatment. Peptic ulcer disease a chronic disease of stomach and duodenum where the protective layer of stomach and duodenum weakens by many factors most common is H Pylori infection. Infection of H Pylori cause ulcer over time.
This presentation is to help readers to be equipped with knowledge on predisposing factor to peptic ulcer disease and how it can be managed in the clinical/hospital setup.
This presentation is to help readers to be equipped with knowledge on predisposing factor to peptic ulcer disease and how it can be managed in the clinical/hospital setup.
New Explore Careers and College Majors 2024.pdfDr. Mary Askew
Explore Careers and College Majors is a new online, interactive, self-guided career, major and college planning system.
The career system works on all devices!
For more Information, go to https://bit.ly/3SW5w8W
This comprehensive program covers essential aspects of performance marketing, growth strategies, and tactics, such as search engine optimization (SEO), pay-per-click (PPC) advertising, content marketing, social media marketing, and more
Exploring Career Paths in Cybersecurity for Technical CommunicatorsBen Woelk, CISSP, CPTC
Brief overview of career options in cybersecurity for technical communicators. Includes discussion of my career path, certification options, NICE and NIST resources.
Resumes, Cover Letters, and Applying OnlineBruce Bennett
This webinar showcases resume styles and the elements that go into building your resume. Every job application requires unique skills, and this session will show you how to improve your resume to match the jobs to which you are applying. Additionally, we will discuss cover letters and learn about ideas to include. Every job application requires unique skills so learn ways to give you the best chance of success when applying for a new position. Learn how to take advantage of all the features when uploading a job application to a company’s applicant tracking system.
Want to move your career forward? Looking to build your leadership skills while helping others learn, grow, and improve their skills? Seeking someone who can guide you in achieving these goals?
You can accomplish this through a mentoring partnership. Learn more about the PMISSC Mentoring Program, where you’ll discover the incredible benefits of becoming a mentor or mentee. This program is designed to foster professional growth, enhance skills, and build a strong network within the project management community. Whether you're looking to share your expertise or seeking guidance to advance your career, the PMI Mentoring Program offers valuable opportunities for personal and professional development.
Watch this to learn:
* Overview of the PMISSC Mentoring Program: Mission, vision, and objectives.
* Benefits for Volunteer Mentors: Professional development, networking, personal satisfaction, and recognition.
* Advantages for Mentees: Career advancement, skill development, networking, and confidence building.
* Program Structure and Expectations: Mentor-mentee matching process, program phases, and time commitment.
* Success Stories and Testimonials: Inspiring examples from past participants.
* How to Get Involved: Steps to participate and resources available for support throughout the program.
Learn how you can make a difference in the project management community and take the next step in your professional journey.
About Hector Del Castillo
Hector is VP of Professional Development at the PMI Silver Spring Chapter, and CEO of Bold PM. He's a mid-market growth product executive and changemaker. He works with mid-market product-driven software executives to solve their biggest growth problems. He scales product growth, optimizes ops and builds loyal customers. He has reduced customer churn 33%, and boosted sales 47% for clients. He makes a significant impact by building and launching world-changing AI-powered products. If you're looking for an engaging and inspiring speaker to spark creativity and innovation within your organization, set up an appointment to discuss your specific needs and identify a suitable topic to inspire your audience at your next corporate conference, symposium, executive summit, or planning retreat.
About PMI Silver Spring Chapter
We are a branch of the Project Management Institute. We offer a platform for project management professionals in Silver Spring, MD, and the DC/Baltimore metro area. Monthly meetings facilitate networking, knowledge sharing, and professional development. For event details, visit pmissc.org.
3. INTRODUCTION
• Peptic Ulcer is a lesion in the lining
(mucosa) of the digestive tract, typically in
the stomach or duodenum, caused by the
digestive action of pepsin and stomach
acid.
4. Lesion may subsequently occur into the lamina
propria and submucosa to cause bleeding. –
Most of peptic ulcer occur either in the
duodenum, or in the stomach – Ulcer may also
occur in the lower esophagus due to reflexing of
gastric content – Rarely in certain areas of the
6. Under normal conditions, a physiologic balance
exists between gastric acid secretion and
gastroduodenal mucosal defense. Mucosal injury
and, thus, peptic ulcer occur when the balance
between the aggressive factors and the
defensive mechanisms is disrupted. Aggressive
factors, such as NSAIDs, H pylori infection,
alcohol, bile salts, acid, and pepsin, can alter the
mucosal defense by allowing back diffusion of
hydrogen ions and subsequent epithelial cell
injury.
7. ETIOLOGY/ RISK FACTORS
• Lifestyle
– Smoking
– Acidic drinks
– Medications
• H. Pylori infection
– 90% have this bacterium
– Passed from person to
person (fecal-oral route
or oral-oral route)
• Age
– Duodenal 30-40
– Gastric over 50
• Gender
– Duodenal: are increasing
in older women
• Genetic factors
– More likely if family
member has Hx
• Other factors: stress
can worsen but not the
cause
15. DIAGNOSTIC TEST
• Esophagogastrodeuodenoscopy (EGD)
– Endoscopic procedure
• Visualizes ulcer crater
• Ability to take tissue biopsy to R/O cancer and diagnose
H. pylori
– Upper gastrointestinal series (UGI)
• Barium swallow
• X-ray that visualizes structures of the upper GI tract
– Urea Breath Testing
• Used to detect H.pylori
• Client drinks a carbon-enriched urea solution
• Exhaled carbon dioxide is then measured
16. In all patients with “Alarming symptoms” endoscopy
is required.
Dysphagia.
Weight loss.
Vomiting.
Anorexia.
Hematemesis or Melena
17. Complications of Peptic Ulcers
• Hemorrhage
– Blood vessels damaged as ulcer erodes into the muscles of
stomach or duodenal wall
– Coffee ground vomitus or occult blood in tarry stools
• Perforation
– An ulcer can erode through the entire wall
– Bacteria and partially digested food spill into
peritoneum=peritonitis
• Narrowing and obstruction (pyloric)
– Swelling and scarring can cause obstruction of food leaving
stomach=repeated vomiting
18. MANAGEMENT
• LIFE STYLE MODIFICATION
• HYPOSECRETORY DRUG THERAPY
• H. pylori ERADICATION THERAPY
• SURGERY
19.
20. Hyposecretory Drugs
• Proton Pump Inhibitors
– Suppress acid production
– Prilosec, Prevacid
• H2-Receptor Antagonists
– Block histamine-stimulated
gastric secretions
– Zantac, Pepcid, Axid
• Antacids
– Neutralizes acid and
prevents formation of pepsin
(Maalox, Mylanta)
– Give 2 hours after meals
and at bedtime
• Prostaglandin Analogs
– Reduce gastric acid and
enhances mucosal
resistance to injury
– Cytotec
• Mucosal barrier fortifiers
– Forms a protective coat
• Carafate/Sucralfate
– cytoprotective
22. Indications:
Failure of medical treatment.
Development of complications
High level of gastric secretion and
combined duodenal and gastric ulcer.
Principle:
Reduce acid and pepsin
secretion.
23. Types of Surgical Procedures
• GASTROENTEROSTOMY
Creates a passage between
the body of stomach to small
intestines.
Allows regurgitation of alkaline
duodenal contents into the
stomach.
Keeps acid away from ulcerated
area
25. Types of Surgical Procedures
• PYLOROPLASTY
– Widens the pylorus
to guarantee
stomach emptying
even without vagus
nerve stimulation
26. Types of Surgical Procedures
• ANTRECTOMY/ SUBTOTAL GASTRECTOMY
– Lower half of stomach (antrum) makes most of the
acid
– Removing this portion (antrectomy) decreases acid
production
• SUBTOTAL GASTRECTOMY
– Removes ½ to 2/3 of stomach
• Remainder must be reattached to the rest of the
bowel
– Billroth I
– Billroth II
27. Billroth I
• Distal portion of the
stomach is removed
• The remainder is
anastomosed to the
duodenum
28. Billroth II
• The lower portion
of the stomach is
removed and the
remainder is
anastomosed to
the jejunum
29. Postoperative Care
– NG tube – care and management
– Monitor for post-operative complications
30. Post-op Complications
• Bleeding
– Occurs at the anastomosed site
– First 24 hours and post-op days
4-7
• Duodenal stump leak
– Billroth II
– Severe abdominal pain
– Bile stained drainage on
dressing
• Gastric retention
– WILL NEED TO PUT NG TUBE
BACK IN
• Dumping Syndrome.
– Prevalent with sub total gastrostomies
– Early-30 minutes after meals
– Vertigo, tachycardia, syncope, sweating,
pallor, palpitations
– Late – 90 min-3 hours after meals
• Rx: Decrease CHO intake, Eat slowly, Avoid
fluids during meals, Increase fat, Eat small,
frequent meals
• Anemia
– Rapid gastric empyting decreases
absorption of iron
• Malabsorption of fat
– Decreased acid secretions, decreased
pancreatic secretions, increased upper
GI mobility
31. Summary
• H. pylori is the most common cause of PUD and
is a risk factor for gastric cancer
• H Pylori eradication reduces risk of disease
recurrence
• Test-and-Treat strategy is recommended for
patients with undifferentiated dyspepsia
• Intial evaluation with endoscopy is recommended
for those with alarm symptoms or those failing
treatment
• Optimum treatment regimens are 14d multidrug
with antibiotics and acid suppressants(Triple
therapy)
32. REFERENCES
• http://emedicine.medscape.com/article/181753-overview#showall. Retrieved 28th
Jan,
2016
• Fendrick M, Forsch R etal. Peptic Ulcer Disease Guidleines for Clinical Care.
University of Michigan Health System May 2005
• American Gastroenterological Association medical position statement: evaluation of
dyspepsia. Gastroenterology 1998;114:579-81.
• Krogfelt K, Lehours P, Mégraud F. Diagnosis of Helicobacter pylori Infection.
Helicobacter 2005 10:s1 5
• Meurer L, Bower D. Management of Helicobacter pylori Infection. American Family
Physician Vol 65, No. 7, 2002 pp 1327-1336
• Standards of Practice Committee of the American Society for Gastrointestinal
Endoscopy; The role of endoscopy in dyspepsia. Gastrointestinal Endoscopy Vol 54,
No. 6, 2001 pp 815-817
• Vaira D, Gatta L, Ricci C, et al. Peptic ulcer and Helicobacter pylori: update on testing
and treatment. Postgrad Med 2005;117(6):17-22, 46