PEPTIC ULCERS Gastroenterology University of Pretoria Pretoria Academic Hospital Obedy Mwantembe 04 May, 2004 11/8/2018
Definition – Peptic Ulcer An ulcer in the Lower oesophagus Stomach Duodenum Acute or Chronic 11/8/2018
Ulcer or Erosion Muscularis Mucosae Duodenal Ulcer Oesophageal ulcers Small bowel ulcers 11/8/2018
Epideomiology Up to 10-12% in one’s life time 11/8/2018
Duodenal Ulcer Male:Female 5-2:1 90% H.pyroli 11/8/2018
Gastric Ulcer Male:Female 2:1 Up to 70% h. pyroli 11/8/2018
AETIOLOGY Helicobacter Pyroli Age 12 nearly 100% Europe 30-40% DU – 90% GU – 70% Non-Steroidal anti-inflammatory drugs (NSAIDs) Inhibit cyclo-oxygenase activity Reduce formation of protective PGE 11/8/2018
AETIOLOGY Heredity Smoking Stress ulcers DU closer than GU especially if below 20y Blood Group O Smoking GU than DU Difficult healing Stress ulcers 11/8/2018
AETIOLOGY Acid-pepsin and acid Vs Defensive factors (Gastric mucosal barrier) No ulcer No acid (Pernicious Anaemia) Too much acid – severe ulcerations 11/8/2018
CHRONIC ULCER 90% in lesser curve within antrum or at junction between body and antral mucosa (stomach) Duodenal ulcers 1st part 50% anterior wall 11/8/2018
THE CLINIC Recurrent abdominal pain Epigastrium Related to food Episodic History a questionable indicator of the presence of an ulcer 11/8/2018
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