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Ulcer
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Peptic Ulcer Disease
Peptic Ulcer Disease
Peptic Ulcers Definition:
Ulcerated lesion in the mucosa of the stomach or duodenum
Types: Gastric Duodenal
Stomach Defense Systems Mucous layer
Coats and lines the stomach First line of defense
Bicarbonate Neutralizes acid
Prostaglandins Substances that keep blood vessels dilated
for good blood flow Stimulates mucus and bicarbonate
production
Risk Factors Lifestyle
Smoking Acidic drinks Medications
Helicobacterium Pylori infection
90% have this bacterium
Passed from person to person (fecal-oral route or oral-oral route)
Age Duodenal 30-50 Gastric over 60
Gender Duodenal: are
increasing in older men
Genetic factors More likely if a family
member has H.P.
Other factors stress can worsen it
but not the cause
Gastric Ulcers Pain occurs 1-2 hours after meals Pain usually does not wake-up the
patient Accentuated by ingestion of food Risk for malignancy Deep and penetrating and usually
occur on the lesser curvature of the stomach
Gastric and Duodenal Ulcers
Duodenal Ulcers Pain occurs 2-4 hours after meals Pain wakes up patient Pain relieved by food Very little risk for malignancy
General Peptic Ulcer Symptoms Epigastric tenderness
Gastric: epigastrium; left of midline Duodenal: mid to right of epigastrium
Sharp, burning pain Dyspepsia (indigestion) Nausea/vomiting
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 fool spill into
peritoneum=peritonitis
Drug Therapy/Primary Goals Provide pain relief
Antacids and mucosa protectors Eradicate Helicobacterium pylori infection
Two antibiotics and one acid suppressor Heal ulcer
Eradicate infection Protect until ulcer heals
Prevent recurrence Decrease high acid stimulating foods in susceptible
people Avoid use of potential ulcer causing drugs Stop smoking
Surgery Required if ulcer is in one of these
stages:
Perforated and overflowed into the abdomen
Scarred or swelled so that there is obstruction
Acute bleeding Non-responsive to medications
Types of Surgical Procedures Gastroenterostomy allows regurgitation of
alkaline duodenal contents into the stomach
creates a passage between the body of stomach to small intestines
keeps acid away from ulcerated area
Types of Surgical Procedures Vagotomy
Cuts vagus nerve Eliminates acid-
secretion stimulus
Surgical Procedure/Pyloroplasty
Pyloroplasty Widens the
pylorus to guarantee stomach emptying even without vagus nerve stimulation
BIBLIOGRAPHY “Peptic Ulcer Disease”. SlideShare.net< http://www.slideshare.net/kapradh/peptic-
ulcer-disease>