Peptic Ulcer Disease By:Rezhwan Omer JwamerUniversity Of Sulaimani

IntroductionPathomorphologyEtiologySymptomsComplicationsDiagnosis Pharmacotherapysurgical interventionPreventionObjectives:

Introduction Terminologically:-

Peptic Ulcer ( Peptikos able to digest & Ulcus a sore ).

Definition:-

Ulcers are open sores that develop on the lining of the :

1-Esophagus(esophageal ulcers)2-Stomach (gastric ulcers)3-First part of the small intestine-Duodenum(duodenal ulcers)

Ages Affected

Peptic ulcer disease affects about 4.6 million people annually.

Phathomorphology

Etiology

(20th Century)

Ulcers are believed to be caused by stress and dietary factors.

1982

Australian physicians Robin Warren and Barry Marshall first identify the link between (H.pylori and ulcers).

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)-Are the second most common causes of Peptic ulcers.

-They are a class of drugs that provides analgesic (pain-killing) and antipyretic (fever-reducing)

-Such as (aspirin , Ibuprofen, Diclofenac , Naproxen . )

-When used for weeks or months, NSAIDs can damage the lining of the digestive tract, causing an ulcer or making an existing ulcer worse.

Symptoms

Symptoms of gastric ulcer disease:

epigastric pain after meal or during meal

upper dyspeptic syndrome loss of appetite, nausea, vomiting, flatulence

vomiting brings relief

reduced nutrition

loss of weight

The pain may radiate to the back if it has penetrated posteriorly.

Gastric ulcer pain is aggravated by meals.

Symptoms of duodenal ulcer disease:

epigastric pain 2 hours after meal or on a empty stomach or during night

pyrosis

good nutrition

obstipation

seasonal dependence (spring, autumn)

Duodenal ulcer is relieved by meal.

ComplicationsInternal bleeding:most common,occurs when an ulcer develops at a site of a blood vessel, and can causes anemia Perforation: Rare(It affects around 1 in 350),causes peritonitis Gastric outlet obstruction: uncommon,(It affects around 1 in 1,000)

BleedingPerforationObstruction

DiagnosisRadiological Diagnosis:

By using Barium X-ray or Upper GI series.

Upper GI series (UGI): This is a type X-ray. The patient is given a chalky liquid to drink that increases the contrast on the X-ray, making certain features easier to see.

EndoscopicDiagnosisflexible tube with a tiny camera on the end. The patient is given a mild sedative,and then the tube is passed through the mouth into the stomach

PharmacotherapyAntibiotic medications to kill H. pylori.

Such as :tetracycline,metronidazole(Flagyl), evofloxacin

2- Medications that block acid production and promote healing.

Proton pump inhibitors reduce stomach acid by blocking the action of the parts of cells that produce acid.

such as omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix)

3-Medications to reduce acid production.Acid blockers also called histamine (H-2) blockers

reduce the amount of stomach acid released into your digestive tract

such as ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid).

4-Antacids that neutralize stomach acid.Antacids can provide symptom relief.

5-Medications that protect the lining of your stomach and small intestine.include sucralfate (Carafate) and misoprostol (Cytotec).

Surgical interventionreason for surgical intervention is the failure of medical therapywe have three types of surgery for peptic ulcer:vagotomy.Antrectomy and truncal vagotomypyloroplasty

Vagotomy

Antrectomy

pyloroplasty

PreventionPeptic ulcers can be prevented by avoiding

alcohol

smoking

NSAIDs (aspirin)

and caffeine.

to avoid H.pylori you should avoid contaminated water and food