Peptic Ulcer Disease

Peptic Ulcer Disease
 There are active ingredients in our stomach juices that helps in breaking down food for
digestion. These are the pepsin and stomach acid. These juices will pass into the first
part of the small intestine or the duodenum and these juices are highly corrosive or
harmful.
 Our gastrointestinal tract has a protective mucous lining that insulates it from the
substances inside. In peptic ulcer disease, this protection fails and the digestive juices
corrode thru the lining.
Two main causes of PUD
 Helicobacter pylori (H. pylori) infection: A type of bacteria that can weaken the
stomach's protective lining.
 Use of nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like aspirin and
ibuprofen that can irritate or damage the stomach lining.
Signs & Symptoms
 Burning or aching stomach pain, often between meals or at night. This is due to the
stomach acid irritating the exposed tissue of the ulcer, which happens more severely
when the stomach is empty (between meals or at night) because there is no food to
buffer the acid.
 Nausea, bloating, or feeling full quickly. This happen because the ulcer disrupts the
normal digestive process. It causes irritation, slows the gastric emptying, leading to
abnormal gastric motility.
 In severe cases, ulcers may bleed, causing vomiting of blood or passing black, tarry
stools. This happen when the ulcer erodes into the blood vessels in the stomach or
duodenum.
In peptic ulcer disease (PUD), bleeding can occur when an ulcer erodes into a blood vessel. The
location and severity of bleeding can vary, leading to differences between upper
gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB). Here's how they
differ:
1. Upper Gastrointestinal Bleeding (UGIB):
Bleeding occurs when an ulcer erodes into a large blood vessel, such as the gastric or duodenal
arteries. Above the ligament of Treitz, which typically includes the esophagus, stomach, and
duodenum.
Symptoms:
 Hematemesis (vomiting blood), which may be bright red (fresh blood) or coffee-
ground (partially digested blood). Hematemesis in peptic ulcer disease happens when
an ulcer erodes into a blood vessel in the stomach or duodenum, leading to bleeding.
The blood mixes with stomach acid and digestive enzymes, and the body may attempt
to expel it by vomiting. The appearance of the blood in vomit (bright red or coffee-
ground) depends on how much time the blood has been in contact with stomach acid.
 Melena (black, tarry stools), a result of blood being digested in the stomach.
 Signs of hypovolemia (low blood volume), such as dizziness, hypotension, or
tachycardia, especially if bleeding is significant.
2. Lower Gastrointestinal Bleeding (LGIB):
Lower GI bleeding from peptic ulcer disease is rare but can occur if an ulcer erodes into a major
vessel in the distal duodenum or through a complication like perforation or fistula formation.
Bleeding originates from sources below the ligament of Treitz, which includes the jejunum,
ileum, colon, rectum, and anus. While upper GI bleeding is more common in PUD, some cases
of severe or extensive ulcers can cause lower GI bleeding if the ulcer penetrates deeply enough
to reach the large intestine.
Symptoms:
 Hematochezia (bright red or maroon-colored blood in the stool) – this typically suggests
active bleeding from the lower GI tract.
 Less likely to present with melena, as blood from the lower tract may not be digested as
much before passing through the rectum.
 Abdominal pain or discomfort may accompany lower GI bleeding, depending on the
location of the bleeding source.
In summary, upper GI bleeding in peptic ulcer disease is the more common and typical
manifestation, while lower GI bleeding may occur in more severe or complicated cases.
Risk Factors
In summary, diseases such as liver, kidney, and chronic pulmonary diseases can increase the
risk of developing peptic ulcer disease through:
 Alterations in stomach acid production or mucosal defenses.

 Increased use of medications (like NSAIDs, corticosteroids) that predispose to ulcers.
 Altered systemic physiology (like uremia or systemic inflammation) that compromises
stomach protection.
 Higher susceptibility to infections like Helicobacter pylori.
These factors, individually or in combination, can make the gastrointestinal tract more
vulnerable to injury from stomach acid, leading to peptic ulcer disease.

Peptic Ulcer Disease

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Peptic Ulcer Disease

 Alterations in stomach acid production or mucosal defenses.

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