4A peptic ulcer is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach 1-Pylorus (opening between stomach and (duodenum2-Duodenum3-Esophagus :occur as a result of the backward flow of HCl from the stomach into the esophagus
5Risk factors people between the ages of 40 and 60 years. After menopause, the incidence of peptic ulcers in women is almost equal to that in menCauses:1-infection with the gram-negative bacteria H. pylori2-excessive secretion of HCla- stressb- milk and caffeinated beverages,c- smoking, and alcohol
6Risk factors3-genetic link is noted in the finding that people with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB4-chronic use of NSAIDs
7pathophysiology The erosion is caused by the: * increase concentration or activity of acid-pepsin*by decreased resistance of the mucosa1-a damaged mucosa cannot secrete enough mucus to act as a barrier against HCl.2-the use of NSAIDs inhibits the secretion of mucusthat protects the mucosa.
8Stress ulcer is common in ventilator-dependent acute mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events such as:*burns*shock*severe sepsis*multiple organ traumasStress ulcer is common in ventilator-dependentpatients after trauma or surgery.
9*endoscopy within 24 hours after injury reveals shallow erosions of the stomach wall by 72 hours, multiple gastric erosions are observed.*When the patient recover the lesions are reversed.
10Pathophysiology of stress ulcer: It preceded by shock; this leads to:* decreased gastric mucosal blood flow*reflux of duodenal contents into the stomach*In addition, large quantities of pepsin are released.*The combination of ischemia, acid, and pepsincreates an ideal climate for ulceration.
11Clinical Manifestations *Many people have symptomless ulcers*in 20% to 30% hemorrhage may occur*pain stimulates the exposed nerve endings.1-Pain is usually relieved by eating or by taking alkali or by taking antacid*burning sensation in the midepigastrium*pyrosis (heartburn)*vomiting*constipation or diarrhea( diet and medications).*Bleeding 15% of pt’s
12Assessment and Diagnostic Findings *physical examination may reveal pain , epigastric tenderness , abdominal distention.*endoscopy is the preferred diagnostic procedurebecause itA- allows direct visualization of inflammatory changes, ulcers, and lesionb-It may reveal lesions that are not evident on x-ray studies because of their size or location.
13Assessment and Diagnostic Findings Stools may be tested for occult blood**H. pylori infection may be determined by biopsy and histology with culture.*serologic test for antibodies to the H. pylori antigen*breath test that detects H. pylori*Pain that is relieved by ingesting food or antacids
14*medications *lifestyle changes *Surgical intervention Medical Management*medications*lifestyle changes*Surgical intervention
15PHARMACOLOGIC THERAPY :combination of*Antibiotics*proton pump inhibitors*bismuth salts(that suppresses or eradicates H. pylori)*histamine2 (H2) receptor antagonists and proton pump inhibitors are used to treat NSAID-induced and other ulcers not associated with H. pylori ulcers
16:*lifestyle changes *STRESS REDUCTION AND REST 1-The patient may benefit from regular rest periods during the day, at least during the acute phase of the disease2-Behavior modification may be helpful.
17:*SMOKING CESSATIONStudies have shown that smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum.Research indicates that continuing to smoke cigarettes may significantly inhibit ulcer repair
18DIETARY MODIFICATION *The goal is to avoid oversecretion of acid. *Avoid alcohol , coffee.*Avoid diets rich in milk and cream.*eating three regular meals a day.. *avoid ulcerogenic medications(NSAIDs)
19SURGICAL MANAGEMENT*surgery is usually recommended for pt’s who fail to heal after 12 to 16 weeks of medical treatment.*perforation.*life-threatening hemorrhage.*obstruction.*Patients who need ulcer surgery may have had a long illness.