Peptic ulcer disease refers to ulcers in the GI tract exposed to acid and pepsin. The most common types are duodenal and gastric ulcers. H. pylori infection and NSAID use are the most common causes. Symptoms include epigastric pain that may wake one at night. Complications can include bleeding and perforation. Diagnosis involves endoscopy with biopsy to test for H. pylori. Treatment involves eliminating H. pylori with antibiotics, reducing acid with PPIs, and lifestyle modifications. Refractory ulcers may require surgery.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.
In this slide, you can understand the concept of Nausea and vomiting normally called "puke.''
Difference between Nausea and vomiting.
Causes of Vomiting.
Diet in Vomiting
Treatment in Vomiting.
Treatment of Vomiting in Pregnancy.
PPT download link.
https://drive.google.com/open?id=1beZMVQ75fdiGJlJDbGJKK3MGio6zgpLfTu9flkBSutk
Video Link:
https://youtu.be/ZvUiGpjt3zc
A chronic, progressive disease characterized by widespread fibrosis(scarring) and nodule formation.
The development of cirrhosis is an insidious, prolonged course, usually after decades of chronic liver disease.
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Image result for gastritis
Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.
In this slide, you can understand the concept of Nausea and vomiting normally called "puke.''
Difference between Nausea and vomiting.
Causes of Vomiting.
Diet in Vomiting
Treatment in Vomiting.
Treatment of Vomiting in Pregnancy.
PPT download link.
https://drive.google.com/open?id=1beZMVQ75fdiGJlJDbGJKK3MGio6zgpLfTu9flkBSutk
Video Link:
https://youtu.be/ZvUiGpjt3zc
A chronic, progressive disease characterized by widespread fibrosis(scarring) and nodule formation.
The development of cirrhosis is an insidious, prolonged course, usually after decades of chronic liver disease.
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Image result for gastritis
Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Introduction
• Peptic ulcer disease (PUD) refers to ulceration of the mucosa
anywhere in the GI tract exposed to acid and pepsin.
• Ulcers : breaks in the mucosal surface >5 mm, with depth to the
sub-mucosa.
• They can range in size from a few millimeters to a few centimeters
• The 2 most common forms/locations of PUD are
– Duodenal ulcer
– Gastric ulcer
Site
• Lower esophagus
• Stomach
• Duodenum
3. Types
Acute
• Superficial erosion
• Minimal erosion
Chronic
• Muscular wall erosion with formation of fibrous tissue
• Present continuously for many months or intermittently
4. Aggressive factors
Hydrochloric acid and
pepsin
destroy gastric and duodenal
mucosa.
Defensive factors
Mucus and bicarbonate
ion secretions
protect mucosa Na
bicarbonate is considered as a
buffer so it inhibits auto
digestion of the stomach wall
Prostaglandins (PGE2 &
PGI2)
protect
mucosa
by
inhibiting acid
secretion
increasing mucus and
bicarbonate production
enhancing mucosal
blood flow.
• Imbalance between aggressive factors (acid &pepsin) and defensive factors (e.g. prostaglandins, mucus &
bicarbonate layer).
• However, nowadays, it seems that H. pylori is a major cause
Pathophysiology
One of the main action of
Prostaglandins is increase the
turnover and regeneration of damaged
cells
8. • Helicobacter pylori (HP) is a spiral shaped,
gram negative, flagellated bacteria first
associated with PUD in the early 1980’s
• Found in most people with duodenal and
gastric ulcers
– About 95% of those with duodenal ulcers
– About 80% of those with gastric ulcers
• HP is primarily spread through the fecal to
oral route
• People are most often infected during
Helicobacter pylori
9. • Mechanisms by which HP causes mucosal
injury are not entirely clear but occurs
through a combination of the following
mechanisms:
– HP catalyzes urea ammonia is produced
ammonia erodes the mucous barrier and
causes epithelial damage
– HP produces cytotoxins
– HP produces mucolytic enzymes
10. NSAIDs
• In long-term NSAID users, there is a 10% -
20% prevalence of gastric ulcers and a 2%
- 5% prevalence of duodenal ulcers
• Mechanisms for NSAID-induced ulceration
– NSAIDs are weak acids and are non-ionized
at gastric pH
• Diffuse freely across the mucous barrier
into gastric epithelial cells H+ ions are
liberated and cause cellular damage
• Aspirin is the most ulcerno-genic of all NSAIDs.
11. • NSAIDs inhibit cyclooxygenase activity
and therefore decrease prostaglandin
production which results in a:
• Reduction in gastric and mucosal blood
flow
• Decrease in mucous and bicarbonate
secretion
• Decrease in cellular repair and
replication
– Greater than 60 years old
– With a prior history of PUD
12. Zollinger Ellison Syndrome
• ZES is characterized by gastric acid hypersecretion and
recurrent peptic ulcers that result from a gastrin-
producing tumor
– More than 50% of gastrinomas are malignant
• ZES is suspected for patients with multiple ulcers and
recurrent or refractory PUD often accompanied by
esophagitis or ulcer complications
• Only accounts for 0.1% to 1% of those with duodenal
ulcer
13. Other factors
• Cigarette smoking
– Impairs ulcer healing and increases the risk of
recurrence
• Psychological stress
– Stress may induce behavioral risks such as smoking
and the use of NSAIDs or may alter the inflammatory
response or resistance to HP infection
• Dietary factors
– Certain foods (e.g. coffee, tea, carbonated beverages,
beer, milk, spices) may cause dyspepsia but do not
increase the risk of developing PUD
14. Signs and symptoms
• Symptoms depend on ulcer location, ulcer
etiology, and patient age
• Many patients, particularly the elderly, have few
or even no symptoms
• NSAID-induced ulcers are often silent
– Complications such as bleeding and
perforation are often the initial presentation
15. • Pain localized to the epigastrium is the most common
symptom
• The pain is described as burning, gnawing, cramping, or
hunger
• A typical nocturnal pain that wakes the patient from
sleep (especially between 12 and 3am)
• The severity of ulcer pain varies from patient to patient
and may be seasonal, occurring more often in the spring
or fall
16. • Episodes of pain usually occur in clusters,
lasting up to a few weeks followed by a pain-free
period or remission lasting weeks to years
• Changes in the character of pain may suggest
the presence of complications
• Pyrosis (heartburn), belching, and bloating may
accompany the pain
17.
18. Gastric Ulcers
• Less common than duodenal ulcers
– Especially in chronic NSAID use
• Most commonly located in the lesser curvature of the
antrum of the stomach
• More common in people greater than 60 years old
Characterized by
• A normal to low secretion of gastric acid
• Back diffusion of acid is greater (chronic )
• Critical pathologic process is amount of acid able to penetrate mucosal barrier
• H pylori is present in 50% to 70%
• Drugs --- Aspirin, corticosteroids, N SAIDs, reserpine, Chronic alcohol abuse,
chronic gastritis
19. Duodenal Ulcers
• Most common form of PUD
– It is 3 times more common than gastric ulcers
• Usually located in the duodenal bulb of the small
intestine
• Most commonly occurs in people between the
ages of 30 and 50
• Associated with ↑HCl acid secretion
• H.pylori associated in 9 0- 9 5 % of cases
• Diseases with ↑risk of duodenal ulcers
COPD, cirrhosis of liver, chronic pancreatitis,
hyperparathyroidism, chronic renal failure
20. Complications
• 3 major complications
Hemorrhage - 15% of patients with active PUD
Perforation - 7% of patients with active PUD
Gastric outlet obstruction
• Initially treated conservatively
• May require surgery at any time during course of
therapy
21. Diagnostic Studies
• Endoscopy procedure
– Determines degree of ulcer healing after treatment
– Tissue specimens can be obtained to identify H. pylori and to rule out gastric cancer
• Tests for H.pylori
– Noninvasive tests
• Serum or whole blood antibody tests
– Immunoglobin G (I g G)
• Urea breath test
• C 14 breath test
• Fecal antigen test
– Invasive tests
• Biopsy of stomach
• Rapid urease test
22. Rapid Urease Testing
– Rapid urease tests detect the presence of ammonia in the
biopsy sample
– The ammonia is generated by H.pylori urease activity
– Test of choice at endoscopy
– Greater than 90% sensitive and specific
– Easily performed with rapid results
– Tests for active HP infection
23. Urea Breath Test
• Detects the exhalation of radioactive CO2
following ingestion of 13C or 14C radiolabeled
urea
• H. pylori hydrolysis of the radiolabeled urea
results in radiolabeled CO2 production
• 97% sensitivity and 95% specificity
24. Fecal Antigen Test
• Polyclonal antibody test that detects the
presence of H.pylori antigen in the stool
• Sensitivity and specificity similar to urea breath
test
• Patients may have a reluctance to collect stool
samples
25. • The urea breath and fecal antigen tests may be
falsely negative in patients who have recently
taken
– Antibiotics (up to 4 weeks)
– Bismuth compounds (up to 4 weeks)
– Antisecretory agents (up to 2 weeks)
26. • Barium contrast studies
– Widely used
• X- ray studies
– Ineffective in differentiating a peptic ulcer from a
malignant tumor
27. Treatment
Medical regimen consists of
– Adequate rest
– Dietary modification
– Drug therapy
– Elimination of smoking
– Long-term follow-up care
Aim of treatment program
– ↓ degree of gastric acidity
– Enhance mucosal defense mechanisms
– Minimize harmful effects on mucosa
29. Histamine receptor blocks (H2 R blockers)-
famotidine,cimetidine
Used to manage peptic ulcer disease
Block action of histamine on H2 receptors
↓ HCl acid secretion
↓ conversion of pepsinogen to pepsin
↑ ulcer healing
Proton pump inhibitors – pantoprazole, rabeprazole
– Block ATPase enzyme that is important for secretion of HCl acid
Antibiotic therapy
– Eradicate H. pylori infection
– No single agents have been effective in eliminating H. pylori
30. • Antacids – calcium carbinate, MgOH
– Used as adjunct therapy for peptic ulcer disease
– ↑ gastric pH by neutralizing acid
• Anticholinergic drugs- Dicyclomine
– Occasionally ordered for treatment
– ↓ cholinergic stimulation of HCl acid
• Bismuth preparations
• Agents
– Bismuth subsalicylate
– Bismuth exhibits antimicrobial activity against bacterial and viral
gastrointestinal pathogens
31. • Standard triple therapy regimen contains
– Amoxicillin 1000mg twice day + Clarithromycin 500mg twice a day + a
PPI dosed once to twice a day
– Given for 10 to 14 days
• 14 day regimens are generally preferred as 14 day regimens
significantly increases the eradication rate
• Bismuth-based quadruple-therapy contains
– Tetracycline 500mg 4 times day +Metronidazole 250-500mg 4 times a
day + Bismuth subsalicylate 525mg 4 times a day + a PPI once or twice
a day OR H2-receptor antagonist twice a day
32. Refractory Ulcers
• When symptoms, ulcers, or both persist beyond 8 to 12 weeks
despite conventional treatment as previously described or
when several courses of H. pylori eradication therapy fail
• Patient should undergo an upper endoscopy to assess the
situation
• Treatment depends on cause and may include additional H.
pylori eradication attempts, higher PPI dosages, or surgery
33. Nutritional therapy
• Dietary modifications may be necessary so that foods and
beverages irritating to patient can be avoided or eliminated
• Nonirritating or bland diet consisting of 6 small meals a day
during symptomatic phase
• Protein considered best neutralizing food
– Stimulates gastric secretions
• Carbohydrates and fats are least stimulating to HCl acid
secretion
– Do not neutralize well
34. Surgical Treatment
• < 20% of patients with ulcers need surgical
intervention
• Indications for surgical interventions
Intractability
History of hemorrhage, ↑ risk of bleeding
Prepyloric or pyloric ulcers
Multiple ulcer sites
Drug-induced ulcers
Possible existence of a malignant ulcer
Obstruction