Pathology of Peptic Ulcer

PEPTIC ULCERMujahid Nadeem (13612)Ali Raza (13621)Arslan Tahir (13635)Ansar Ali Raza (13665)

CONTENTS INTRODUCTION

TYPES

ETIOLOGY

PATHOGENESIS

INTRODUCTION

INTRODUCTION

Ulcer An ulcer is a discontinuity or break in

a bodily membrane that impedes the organ of which that membrane is a part from continuing its normal functions.

Types of Ulcers

Peptic ulcer i. Esophageal ulcerii. Duodenal ulceriii. Gastric ulcer Pressure ulcerGenital ulcerUlcerative dermatitis Anal fissureDiabetic foot ulcer

Types of Ulcers (Cont.)

Corneal ulcerMouth ulcerVenous ulcer Stress ulcerUlcerative sarcoidosis Ulcerative lichen planusUlcerative colitisUlcerative disposition

Peptic Ulcer

Also known as “peptic ulcer disease” (PUD)

Peptic ulcer is a break in the lining of the stomach, first part of the small intestine, or occasionally the lower esophagus.

Sites of peptic ulcer

Duodenum …………….…… 80%

Stomach …………………….. 19%

Duodenum & Stomach ….. 4%

GE junction ………………….. Meckel’s diverticulum ……. 1%

Occurrence of peptic ulcer

Serious medical problem Approx. 500,000 new cases each

year 5M people affected in USA only Mostly occur between 55 ot 65 years

of age Duodenal ulcer more common in

men than women Gastric ulcer more common in

women than men

Occurrence of peptic ulcer (Cont.)

Duodenal ulcers are four times more common than gastric ulcers

Mortality rates from peptic ulcer are low

High prevalence One of several upper GIT diseases

that is caused ,partially, by gastric acid

Wide range of symptoms

Symptoms

Abdominal pain• Located in epigastric area • Burning in quality• Occur on an empty stomach 2-4

hours after meal or at night (nocturnal pain)

• Relieved by antacids• Tend to wax and wane over months

Symptoms (Cont.)

PerforationsBlotting and abdominal fullnessNausea and vomitingLoss of appetite (because of pain)Weight lossStomach obstructionHeartburnHematemesisMelenaDeep tenderness

TYPES OF PEPTIC ULCER

Acute Peptic Ulcera. Cushing ulcerb. Curling ulcer

Chronic Peptic Ulcera. Duodenal ulcerb. Gastric ulcerc. Esophageal ulcerd. Bleeding ulcere. Refractory ulcer

Acute (Stress) Peptic Ulcer

Cushing Ulcer Gastric, duodenal or esophageal ulcer arising in patients with intercranial injury or operation

Curling Ulcer Occuring mosty in the proximal duodenum and associated with severe burns and trauma

Chronic Peptic Ulcer

Gastric Ulcer A gastric ulcer is a sore that is on the inside of the stomach Causes Infection with Helicobecter pylori NSAIDs (e.g. aspirin, ibuprofen,

diclofenac)

Chronic Peptic Ulcer (Cont.)

Duodenal Ulcer The peptic ulcer having a sore on the upper part of small intestine Causes H.pylori Damaging of lining of mucosal wall

Chronic Peptic Ulcer (Cont.)

Esophageal Ulcer Open sores or lesions in the lining of

esophagus Mostly occur in the lower end of

esophagusCauses Associated with bad case of chronic

gastro esophageal reflux disease or GERD

Chronic Peptic Ulcer (Cont.)

Bleeding Ulcer Internal bleeding is caused by a

peptic ulcer which has been left untreated

When this happens it is now referred to as bleeding ulcer

Most dangerous type of ulcer

Chronic Peptic Ulcer (Cont.)

Refractory Ulcer These are simply peptic ulcers that have not healed after at least 3 months of treatment

ETIOLOGY OF PEPTIC

ULCER

What Causes Ulcers?

No single cause

End result of an imbalance between digestive fluids in stomach and duodenum

Most common cause of ulcer is infection with a type of bacteria called Helicobacter pylori (H.pylori)

Factors that can increase the risk of ulcers

Use of NSAIDs (such as aspirin, naproxen, ibuprofen and many others prescription medicines; even safety-coated aspirin and aspirin in powder form can cause ulcers

Excess acid production from gastrinomas (tumors of acid-producing cells)

Factors that can increase the risk of ulcers

(Cont.) Excessive drinking

Smoking or chewing tobacco

Serious illness

Radiation treatment of the area

Who is more likely to get ulcers?

Those people are more like to get ulcers who:

Are infected with H.pylori Take NSAIDs (aspirin, ibuprofen or naproxen

etc.) Have a family history of ulcers Have another illness such as liver, kidney or

lung disease Drink regularly

Are age 50 or older

How are ulcers treated?

If not properly treated, they can lead to serious health problems

Ulcers can be treated by following ways:

Lifestyle changes

Medication

Surgery

Lifestyle changes

Eliminate substrate that can causing ulcers

Stop drinking and/or smoking

Stop using NSAIDs

Ulcer Medication

Proton Pump Inhibitors(PPIs) Reduce acid level and allow ulcer to heal These include: • Dexlansoprazole, • Esomeprazole• Lansoprazole• Omeprazole• Pantoprazole• Rabeprazole• Omeprazole/sodium bicarbonate etc.

Ulcer Medication (Cont.)

Antibiotics

Used for H.pylori induced ulcers

Multiple combinations of antibiotics are used

Taken for 2-3 weeks along with PPIs

Ulcer Medication

Upper Endoscopy

Bleeding ulcers can be treated using an endoscope

Surgery

Surgery is needed if:

Ulcer creates a hole in the wall of stomach

There is serious bleeding that cannot be controlled with an endoscope

How to reduce the risk of developing ulcers?

Don’t smoke

Don’t drink

Don’t overuse aspirin or NSAIDs

If you have symptoms of ulcer, contact your health care provider

PATHOGENESIS OF PEPTIC

ULCER

H.pylori INDUCED ULCERGram negative bacteria produced heat shock proteins

Cytokines, histamine, lipopolysaccharides, certain enzymes

Phospholipase

Urease, protease, fucosidase etc. Urease convert in acidic media urea into ammonia

and carbon dioxide. Ammonia itself cause destruction of mucosal lining.

Ammonia cause infection of mucosal lining and ultimately inflammatory mediators release.

Cytokines Leukocytes adhesion and inflammatory reactions starts

Damage mucosa of GIT

Ulcer occurs

DRUG INDUCED ULCER

Drugs for example NSAIDS as aspirin(non selectively inhibit cox1 and cox2 in human bodyArachidonic acid cox1,2 Prostaglandins

Controls gastric juice secretions

Damage mucosal lining lead to ulcer

STRESS INDUCED ULCERIn stress energy consumption increase so increase

glycolysis which is usually done by cortisol hormone

This hormone inhibit phospholipase A2

No arachidonic acid formation no prostaglandin increase gastric juice secretions

Cause ulcer

STEROIDS INDUCED ULCER Steroids acts on cell membrane

(phospholipid)

Inhibit phospholipase

Inhibits arachidonic acid no prostaglandins and damaging of mucosal lining

ULCER DUE TO GENETIC DEFECTRare genetics occurs some time having

blood group O positive the size of parietal cell is increase

Increase cell demand as HCL secretions increase

Cause destruction of mucosal lining leading towards ulcer

ZES(Zollinger-Ellison Syndrome)

In this syndrome tumor of goblet cell occurs

Abnormal mucus secretions(gastrin acts on parietal cells)

Increase secretions of gastric juice

Mucosal lining damage

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