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Peptic Ulcer Professor Ravi Kant FRCS (England), FRCS (Ireland), FRCS(Edinburgh), FRCS(Glasgow), MS, DNB, FAMS, FACS, FICS, Professor of Surgery
Surgical Anatomy Crow’s feet N of Latarjet Criminal Nerve of Grassi Antral pump mechanism
Applied Anatomy : Stomach Pressure studies Endoscopic & Chromo-endoscopic Contrast ( Ba meal with air) Intra-luminal USG Electron microscopy USG CT/ MR Surgical
APD= Acid Peptic Disease Peptic Ulcer Gastric Ulcer Duodenal Ulcer Hyperacidity ZE Syndrome
APD= Acid Peptic Disease Acute Ulcer Stress Ulcer Curling’sCushing’s
Peptic Ulcer 10% population affected Gastric ulcer in elderly 5-6 th decade Duodenal ulcer in adults 4 th decade DU also in young
Duodenal Ulcer Proximal duodenum 1 - 2 cm of pylorus ▲ acid Distal duodenum = ZE
Type 1 Gastric Ulcer most common(among gastric Ulcers) proximal antrum mucosal defense acid
Type II Gastric Ulcer Secondary to DU + pyloric stenosis
Type III Gastric Ulcer Prepyloric and pyloric canal ulcer acid ▲ common etiology with DU
GU: Benign Vs CA Rugae upto margins Small, <2cm Sticking of barium + Accompanying spasm ↓ Acid Crater beyond the normal stomach on a barium Rugae-short of Small-Big--Achlorhydria Limited to Stomach
Pathogenesis Imbalance of acid-pepsin and mucosal defence H. pylori infection NSAID ZE Syndrome Type A personality
H.pylori 95% - duodenal ulcer 80% - gastric ulcer mucosal resistance hydrophobicity eradication reduces ulcer recurrence
NSAID Suppress prostaglandins prostaglandin ► acid secretion ▲ mucosal blood flow mucus & bicarbonate secretion 10 -30% in chronic users
ZE= Zollinger Ellison Syndrome RecurrentRecalcitrantResistant Unusual sites MultipleMalignant
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
ZE Syndrome 20% multiple 66% malignant slow growing indolent tumor parietal cell mass increased genetic basis massive hyper-secretion of acid
ZE Syndrome MEN - I – hyperparathyroidism – islet cell tumor – pituitary tumors
A/ DU NSAIDs Acid hypersecretion Rapid gastric emptying Impaired acid disposal Smoking
Duodenal Ulcer Increased secretion of acid More rapid gastric emptying Decreased prostaglandin Chronic duodenitis with H.pylori Smoking
Gastric Ulcer H.pyloriNSAIDs Duodenogastric reflux Impaired gastric mucosal defense
Gastric Ulcer Acid secretion - normal to low Reflux of duodenal contents gastritis ulcer Pylorus sphincter disorder Smoking Disturbed mucosa with low grade gastritis
CP Duodenal Ulcer – pain relieved by food or alkali – pain several hours after meal Gastric Ulcer - gnawing or burning pain on eating
CP Periodic chronic recurrent pain Nausea & vomiting Weight loss Epigastric tenderness
Investigations Endoscopy – 90% sensitivity – must in all pts. with severe pain – excludes malignancy – biopsy can be taken – test for H.pylori
Investigations Barium Meal double (air) contrast – 90% sensitivity
H Pylori detection: Breath test Blood test Tissue test
DD Cholecystitis Hiatus hernia PancreatitisMIPneumonia Dissecting aneurysm Worm Infestations
Rx - Medical Stop smoking, NSAIDs Stop alcohol Antacids - acid neutralisation H 2 receptor antagonist -Ranitidine - secretion inhibition
Rx- Medical H + pump inhibition - H + /K + ase inhibition - Omeprazole Anticholinergic - secretory inhibition Prostaglandin - Misoprostol - mucosal protection
Proton Pump Blockers OmeperazoleEso-meperazoleRabi-meperazole
Rx - Medical Sucralfate - protective coating Colloidal Bismuth – eradicate H.pylori – protective coating Antibiotics - H.pylori Kit for H Pylori
H2 Receptor Antagonists On parietal cells Decrease basal & stimulated acid secretion Pepsin output decreased Decreased gastric blood flow Competitive inhibitor of parietal cell
Rx - Duodenal Ulcer 95% control - medical Rx Surgery-Outdated, Obsolete Omeprazole better thanRanitidine Ulcer heels in 80% by 6 m recurrence in 95% by H.pylori eradication
Rx - Duodenal Ulcer Indications for surgery=Compl –Hemorrhage –Obstruction –Perforation –Intractability of pain Intractable pain ► HSV / TV + GJ
Rx - DU H2 blockers heals 75% DU in 4 weeks H/K proton pump inhibitor better results ulcer may recurr in 80% cases on stopping treatment of H.pylori
Rx - DU Indication of surgery in hemorrhage bleeding of > than 6 units recurrent bleed after endoscopic control pyloro-duodenotomy and control of bleeding HSV or TV + GJ
Rx - DU Perforation - simple closure with omental patch-Graham’s patch definitive surgery –HSV –TV + pyloroplasty –parietal cell vagotomy –TV+GJ
Rx GU Omeprazole, H2 receptor antagonist - 8 weeks if pain not relieved by 2 weeks - add one more drug repeat endoscopy after 8 weeks if no healing by 12 - 115 weeks - Surgery
Rx - GU Type I - Distal Gastrectomy with vagotomy + G-D or GJ proximal ulcer- total gastrectomy parietal cell vagotomy - high recurrence
Hemorrhage Hemorrhage - potential cause of death 15 -20% gross bleeding erosion of duodenal ulcer into gastro-duodenal artery Endoscopy –laser, sclerosant oralcohal injection
Perforation In 5-10% of cases pneumo-peritoneum in 75% cases peritonitis, pain, ileus leukocytosis, hypovolumia, IIIrd space loss DD - acute appendicitis, enteric perf.
Obstruction Chronic ulcer disease with edema and scarring in 5% cases of DU nausea, vomiting, abdominal distension metabolic alkalosis, paradoxical aciduria
Obstruction Endoscopy Ba study Scintigraphy Rx V + G-J / G-D
Peptic ulcer. A peptic ulcer is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach 1-Pylorus (opening between stomach.
Peptic Ulcer Disease. Peptic ulcer refers to erosion of the mucosa lining any portion of the G.I. tract. It is defined as : A circumscribed ulceration.
Stomach and Duodenum AnatomyAnatomy PhysiologyPhysiology Operative proceduresOperative procedures Gastric disordersGastric disorders peptic ulcer diseases.
PEPTIC ULCER DISEASE BERNARD M. Jaffe, MD Professor of Surgery Emeritus.
Peptic Ulcer Disease Dr Maha Arafah. Objectives Upon completion of this lecture the students will : A] Understand the Pathophysiology of acute and chronic.
Peptic Ulcer Disease Biol E /11/06. From: Current Diagnosis & Treatment in Gastroenterology - 2nd Ed. (2003)
Gastrointestinal Block Pathology lecture Nov 20, 2012 Dr. Maha Arafah Dr. Ahmed Al Humaidi Peptic Ulcer Disease.
Gastric and Duodenal Ulcer. 2 What is a Peptic Ulcer? It is a hole that forms in the mucosal wall of the stomach, in the pylorus (opening between stomach.
D YSPEPSIA & P EPTIC U LCER By Dr. Zahoor 1. D YSPEPSIA What is Dyspepsia ? Dyspepsia is used to describe number of upper abdominal symptoms such as.
Functions of stomach Physiology Unit. Secretory and Digestive Functions of the Stomach The objective of the lecture is to discuss the functions of the.
Gastric Acid Secretion 1. Acid synthesis – regulated by 3 transporters Lumen Plasma Parietal cell.
Peptic Ulcer Disease Dr. Wael H. Mansy, MD Assistant Professor College of Pharmacy King Saud University.
Stomach and Duodenum Dr Aqeel Shakir Mahmood Assistant Professor Consultant General and Laparoscopic Surgeon FICMS General Surgery CABS General Surgery.
PEPTIC ULCER DISEASE NRS452 Norhaini Majid. Introduction PUD,a break in a mucous lining of GI tract Duodenal - most common, age Gastric Ulcer –
STOMACH AND DUODENUM Begashaw m (MD). Introduction PUD is a common problem Helicobacter pylori (H. pylori) - important associated risk factor Gastric.
Peptic ulcer disease. Factors influencing Aggressor – Acid – Pepsin – NSAIDs – H.Pylori Defense – Bicarbonate – Blood flow – Mucous – Cell junctions –
PEPTIC ULCER DISEASE Dr RAMBABU POPURI MD MD Asst. Professor Dept of General medicine Dept of General medicine.
Pharmacology B Lin, I-Yao. A 43y/o male CEO of a multinational company experienced severe burning pain one and a half hour after a sumptuous lunch. This.
Peptic ulcer Presented by د. قصي العبيدي بورد ( دكتوراه ) جراحه عامه جامعة الكوفة - كلية طب.
Peptic Ulcer Disease. Condition characterized by Condition characterized by Erosion of GI mucosa resulting from digestive action of HCl and pepsin.
GASTRITIS Primary HP 10%western Countries up to 100% in under developed countries. Primary duodenal ulcer almost always HP Very rare in children below.
PEPTIC ULCER. Ulcers are defined as a breach in the mucosa of the alimentary tract, which extends through the muscularis mucosa into the submucosa or.
Nursing Care of Patients WithUpper GI Disturbances Nursing Management II.
Daguman, Emmanuel II Dadgardoust, Persia. Case 2 45 y/o male c/c: severe abdominal pain.
Barium Studies Still commonly used as a first test for documenting an ulcer 80% sensitivity : single contrast barium study 90% sensitivity: double contrast.
Differential Diagnosis. PUD Gastric ulcer Duodenal ulcer Erosive gastritis Zollinger- Ellison Syndrome Gastrointestinal tumors.
Adult Medical- Surgical Nursing Gastro-intestinal Module: Gastritis and Peptic Ulcer.
Role/ Indications for surgery. Indications for surgery in PUD Bleeding Perforation Obstruction Intractability or nonhealing Schwartz’s Principles of Surgery,
Peptic ulcer disease. A peptic ulcer is a break in the inner lining of the esophagus, stomach, or duodenum. A peptic ulcer of the stomach is called a.
Pharmacotherapy of Gastric Acidity, Peptic Ulcer….
Drugs Used in Gastrointestinal System Prof. : Abdulqader A. ALHAIDER.
Stomach Ulcer(Peptic Ulcer) Stomach ulcer or peptic ulcer is the damage of the protective layer (lining) of stomach or gastrointestinal tract It may be.
Faculty of Allied Medical Sciences Histopathology and Cytology (MLHC-201)
Gastric and Duodenal Ulcer Dr. Belal M. Hijji, PhD, RN April 30 & May 04, 2011.
Peptic ulcers are open sores in the mucosa of the lower oesophagus (esophageal ulcer), duodenum (dudenal ulcer ) and stomach (gastric ulcers). Caused.
Treatment for Upper GI bleeding due to PUD. Goals Control upper GI bleeding Provide symptom relief Promote ulcer healing Prevent recurrence and other.
PEPTIC ULCER DISEASE (PUD) By Dr. Abdelaty Shawky Assistant professor of pathology 1.
By Sarah Hofman Peptic Ulcers. Peptic ulcers They are ulcerations of the mucous membrane or deeper structures of the GI tract. Most commonly occur in.
Surgical Treatment of Ulcers. Anatomy Introduction Number of admissions for uncomplicated disease is falling Incidence of complications related to.
Acid peptic disease Seyed vahid hosseini Professor of surgery Department of surgery Colo-rectal ward.
Copyright (c) 2004 Elsevier Inc. All rights reserved. Drugs for Peptic Ulcer Disease Chapter 73.
Drugs in peptic ulcer (H 2 blockers and proton pump inhibitors) By Prof. Hanan Hagar.
Upper Gastrointestinal Disorders. Gastroesophageal Reflux Disease - GERD.
Peptic Ulcer & its Complications Prof. Dr. Faisal Ghani Siddiqui FCPS; MCPS-HPE; PGDip-bioethics.
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