Download - peptic ulcer
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PEPTIC ULCERBY KHKULA IMTIAZROLL-NO:03
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CONTENTS:DEFINITIONCLASSIFICATION SYMPTOMSCAUSESRISK FACTORSCOMPLICATIONSTESTS AND DIAGNOSIS CHARTTREATMENTLIFE STYLE AND HOME REMEDIES
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DEFINITION: Peptic ulcers are produced by an
imbalance between the gastro-duodenal mucosal defense mechanisms and damaging forces of gastric acid and pepsin, combined with superimposed injury from environmental or immunologic agents.
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Classification:Stomach (called gastric ulcer)Duodenum (called duodenal ulcer)Oesophagus (called Oesophageal ulcer)
Types of peptic ulcers:Type I: Ulcer along the lesser curve of stomachType II: Two ulcers present - one gastric, one
duodenalType III: Prepyloric ulcerType IV: Proximal gastroesophageal ulcerType V: Anywhere
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Pathophysiology:
BicarbonateMucus layerProstaglandinsMucosal blood flowEpithelial renewal
Defensive
Helicobacter pyloriNSAIDsPepsinsBile acidsSmoking and alcohol
Aggressive
Mucosal damage erosions & ulcerations
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ETIOLOGY:
H. Pylori Infection NSAIDsSmoking & AlcoholAcid HypersecretionStress Family History of PUD.
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CLINICAL PRESENTATION
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DUODENAL ULCER:Age: 30-40 yearsSex: More in MalePain: Epigastric region,discomfortOnset: 2 to 3 hrs after eating and midnightAgg.by: hungerRelived by: eatingVomiting: uncommonWeight: no wt lossHematemesis: 40%
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GASTRIC ULCER:Age: middle age 50 to 60 yearsSex: more in FemalePain: Epi. Can radiate to backOnset: Immediately after eatingAgg.by: eatingRelived by:lying down or vomitingVomiting:common(to relive pain)Weight lossHematemesis: 60%
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RISK FACTORS:You’re at risk for peptic ulcer disease if
you:Are 50 years old or older.Diabetes may increase your risk of having
H. pyloriDrink alcohol excessivelySmoke cigarettes or use tobacco.Have a family history of ulcer disease.
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You’re at risk for NSAID-induced ulcers if you:Are age 60 or older (your stomach lining becomes
more fragile with age).Have had past experiences with ulcers and internal
bleedingTake steroid medications, such as prednisone.Take blood thinners, such as warfarin.Experience certain side effects after taking
NSAIDs, such as upset stomach and heartburn.Take NSAIDs in amounts higher than
recommended Take NSAIDs for long periods of timeStress does not cause an ulcer, but may be a
contributing factor
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COMPLICATIONSGastrointestinal bleedingPerforationPenetrationScar tissue(obstruction)
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TESTS AND DIAGNOSIS CHART:
Stool fecal occult blood.
CBC CBL.Rapid Urease test, urea breath test H.
Pylori.
Upper GI Endoscopy.
Barium meal X-Ray
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TREATMENT
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GOALS OF TREATMENT:
lowering the amount of acid that stomach makes,
neutralizing the acid protecting the injured area so it can healIt's also very important to stop smoking
and drinking alcoholPrevent complications (bleeding,
perforation, penetration, obstruction).
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Life Style Change
Medical
Surgical
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LIFE STYLE MODIFICATIONSmoking cessationAlcohol cessationStop using NSAIDsStress reduction
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MEDICATIONSAntacidsH2-receptor blocking agents. Proton pump inhibitors.Cytoprotective and antisecretory drugs.Antibiotics.
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SURGICAL Indications:
Failure of medical treatment.
Development of complications
High level of gastric secretion and combined
duodenal and gastric ulcer.
Principle:
Reduce acid and pepsin secretion.
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VagotomyAnterctomyPyloroplastyHemigastrectomy
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Thanks