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    Peptic Ulcer Disease: Madalitso Kamwachale College of Health Sciences

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    Peptic Ulcer Disease: Madalitso Kamwachale College of Health Sciences

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    Bright Kumwenda
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    2 views31 pages

    Peptic Ulcer Disease: Madalitso Kamwachale College of Health Sciences

    Uploaded by

    Bright Kumwenda
    PUD

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 31

    Peptic Ulcer Disease

    MADALITSO KAMWACHALE
    College of Health Sciences
    Peptic Ulcer
    • A break in the epithelial surface of the oesophagus,
    stomach and duodenum.
    • Due to action of gastric secretions –acid peptic juices
    • In case of duodenal ulceration is due to infection
    with helicobacter pylori
    • All share the symptom of epigastric pain

    N.b: Ulcer: breach in muscularis mucosa of GI


    tract
    Acute Peptic Ulcer
    Mucosal injury is due to
    • Helicobacter pylori infection,
    • NSAID use,
    • Alcohol, smoking, corticosteroids use,
    • Excess gastrin secretion by a tumor,
    • Ischemia, bile/pancreatic juice reflux
    • severe physiologic stress (shock,
    extensive burns, sepsis, severe trauma,
    PREDISPOSING FACTORS
    Blood group O
    Imbalance between acid / pepsin
    secretion and mucosal defence
    Defects in mucosal defence
    Alcohol
    Cigarettes and stress
    TYPES PEPTIC ULCERS
     Gastric Ulcers
     Duodenal Ulcers
     Oesophageal Ulcers
    1. GASTRIC ULCER
    Cause
    Associated with
    – Gastritis
    – gastric stasis
    – increased gastric
    secretion.
    – Zollinger Ellison
    Syndrome
    GASTRIC ULCER - CLINICAL FEATURES
    • Epigastric pain
    • Pain induced by
    eating
    • Weight loss
    • Nausea and vomiting
    (may relieve the pain)
    • Anaemia from
    chronic blood loss
    JOHNSON’S GASTRIC ULCER
    2. DUODENAL ULCER

    CLINICAL FEATURES
    • Male: Female, 4:1
    • Occurs between
    25 – 50 years
    • Epigastric pain
    during fasting
    relieved by food
    and antacids.
    DUODENAL ULCER

    Clinical Features
    • Boring back pain if the
    ulcer is penetrating
    posteriorly
    • Nocturnal pain waking
    patient 2-3 am hrs
    • Peritonitis in perforation
    of anterior ulcer
    • Patient looks well
    nourished
    DUODENAL ULCERS
    • Site of ulceration
    Complications of Acute Peptic Ulcers

    • Bleeding,
    • Perforation,
    • Obstruction from edema or stenosis (due
    to scarring)
    Chronic peptic ulcer

    • Usually in pyloric-type mucosa along lesser curvature

    Clinical features:
    • epigastric burning;
    • pain worse at night, within 1-3 hours after meals;
    • pain may decrease with food/alkali;
    • perforation associated with back pain, left upper
    quadrant and chest
    • heals in 15 years without treatment versus weeks
    with treatment
    INVESTIGATIONS
    • FBC
    • U and E’s
    • Endoscopy
    • Barium meal
    TREATMENT
    a. MEDICAL
    • Avoid smoking and food which
    causes pain
    • Antacids for symptom relief
    • H2 blockers/antgonists – cimetidine
    and ranitidine
    Proton pump inhibitors
    Triple therapy ( Amoxicillin +
    Metronidazole + Omeprazole)
    Re – endoscopy patient with gastric
    ulcer because of risk of malignancy
    b. SURGICAL
     Elective for DU- highly selective vagotomy

     Elective for GU –Bilroth 1 gastrectomy

     Performed DU/GU simple closure of perforated

     Haemorrhage – endoscopy control by


    sclerotherapy under sewing blood vessel.
    PERFORATED PEPTIC ULCER.
     It is a common cause of acute abdomen
    SITES OF PERFORATION
    – Anterior duodenal

    – Presents as an acute abdomen

     Management
    – Surgery- laparotomy and repair of defect
    (GRAHAM OMENTAL PATCH).

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