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    Peptic Ulcer

    Uploaded by

    Aayush Lamichhane

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd

    Peptic Ulcer

    Uploaded by

    Aayush Lamichhane
    7 views38 pages

    Copyright

    © © All Rights Reserved

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    KEY, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    7 views38 pages

    Peptic Ulcer

    Uploaded by

    Aayush Lamichhane

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    of 38

    Peptic Ulcer Disease

    Dr. Aayush
    Lamichhane
    MBBS (KU)
    Arterial Supply of Stomach
    Veins of Stomach, Duodenum, Spleen and Pancreas
    Past Questions:
    1) Definition
    2) Aetiology
    3) Clinical Features
    4) Management
    5) Complications
    6) Mx of Complications
    INTRODUCTION
    Peptic Ulcer is defined as disruption of the
    mucosal integrity of stomach and/or
    duodenum leading to a local defect or
    excavation due to active inflammation.
    PATHOPHYSIOLOGY
    H. pylori Mechanisms:
    TYPES
    GASTRIC PEPTIC ULCER
    DUODENAL PEPTIC ULCER
    CLINICAL PRESENTATION
    DIAGNOSTIC TEST
    Endoscopic procedure: most sensitive and specific
    Visualizes mucosa and ulcer crater
    Useful for documentation of mucosal defects
    Ability to take tissue biopsy ( histology, culture, Rapid urease test )
    Test for H. pylori
    Upper gastrointestinal series (UGI)
    Barium swallow
    X-ray that visualizes structures of the upper GI tract
    Urea Breath Testing: non-invasive
    Used to detect H.pylori
    Patient drinks a carbon-enriched urea solution
    Exhaled carbon dioxide is then measured.
    ~ Others:
    * Serology
    * Stool Antigen test
    In all patients with “Alarming symptoms”
    endoscopy is required.

    Dysphagia.
    Weight loss.
    Vomiting.
    Anorexia.
    Hematemesis or Malena or Heme positive stool (GI
    bleeding)
    Iron deficiency Anemia
    Epigastric mass
    Suspicious Barium meal
    Persisting upper abdominal pain, radiating to the back
    Severe, spreading, upper abdominal pain
    MANAGEMENT
    LIFE STYLE MODIFICATION
    Gastric acid secretion inhibitors Drug Therapy
    H. pylori Eradication Therapy
    SURGERY
    Life Style
    Modification:
    Indications of H. pylori Eradication:
    Peptic Ulcer
    H. pylori positive dyspepsia
    MALToma
    Family history of Gastric Carcinoma
    Long term use of NSAIDs
    Indications:
    Failure of medical treatment (Chronic non healing ulcer)
    Recurrent ulcers
    Development of complications (Perforation, hemorrhage)
    Surgery for Duodenal Ulcers:
    Principle:
    Excluding the damaging effects of Acid from duodenum by:
    Diversion of Acid away from duodenum, or
    Reducing the secretory potential of stomach, or
    Both

    Types of Surgeries:
    Billroth II Gastrectomy
    Gastrojejunostomy (Gastroenterostomy)
    Truncal vagotomy
    Highly selective vagotomy
    Trucal vagotomy and Antrectomy
    Billroth II Gastrectomy
    The lower portion of the stomach is removed and the remainder is
    anastomosed to the jejunum.
    GASTROENTEROSTOMY
    (Gastrojejunostomy)
    Creates a passage between the body of stomach to small intestines.

    Allows regurgitation of alkaline duodenal contents into the stomach.


    Keeps acid away from ulcerated area.
    VAGOTOM Cuts vagus nerve
    Y Eliminates acid secretion stimulus
    PYLOROPLASTY
    – Widens the pylorus to guarantee stomach emptying even without vagus nerve stimulation
    Surgery for Gastric Ulcers:
    Principle:
    In contrast to Duodenal ulcer surgeries,when the principle objective was
    to reduce duodenal acid exposure,
    In Gastric ulceration the diseased tissue is usually removed as well.
    Advantage : Malignancy can be confidently excluded.
    Types of Surgeries:
    Billroth I Gastrectomy
    Billroth I Gastrectomy
    Distal portion of the stomach is removed and the remainder is
    anastomosed to the duodenum.
    Sequelae of Peptic Ulcer Surgery:
    Recurrent Ulceration:
    Small Stomach Syndrome
    Bile vomiting
    Dumping Syndrome (Early and Late)
    Post-vagotomy Diarrhea
    Malignant Transformation
    Nutritional Consequences
    Gallstones
    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 food spill into
    peritoneum=peritonitis
    Narrowing and obstruction (pyloric)
    Swelling and scarring can cause obstruction of food leaving stomach=repeated vomiting
    Malignant transformation : rare
    Pancreatitis : due to posterior penetration of ulcer
    Others :
    Hour glass contracture

    Tea pot deformity (Hand bag stomach)

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