stomach (2) - copy
TRANSCRIPT
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Peptic ulcer disease
( PUD )
Dr. Randula Samarasinghe
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Peptic ulcer disease ( PUD )
PUD encompasses both gastric and duodenalulcers
Defnition o an ulcer
- disruption o the mucosal integrity o thestomach or duodenum leading to a local deector excaation due to actie in!ammation
Ulcers are oten chronic and benign
"ommon disorder #alignant ulcer is the main endoscopic
deerential diagnosis
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"auses o PUD
$elicobacter Pylori inection
%on steroidal anti in!ammatorydrugs
&ther
- cigarette smo'ing
- enetic predisposition - "hronic disease
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astric ulcer ( U )
&ccur later in lie ( sixth decade )
#ay be benign or malignant
enign * oten in the distal stomach (antrum )
$. Pylori and %S+,D induced inuryaccount or the maority o DU andU
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Duodenal ulcer ( DU )
end to occur earlier in lie /hencompared to U
Reduced incidence seen in /esternpopulation due to $. Pylorieradication treatment
01 2 seen in 3stpart o duodenum
4ast maority o DU are benign
#alignant duodenal ulcer extremelyrare
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$elicobacter Pylori
ram negatie spiral shaped bacterium
&nce person is inected the organism isound bet/een the gastric epithelium and
the mucous gel layer Produces urease /hich conerts urea to
amonium and ma'es the surrounding areaal'aline
$. Pylori inection is al/ays associated /ithchronic actie gasritis.
&nly 35 2 to 31 2 deelop ulcer
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Spread * person to person
67eaco-oral8 oro-oral
"hronic inection by $. Pylori can result in
- gastritis
- peptic ulcer disease
- gasrtic lymphoma
- gastric carcinoma subse9uent tointestinal metaplasia
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Detection o $. Pylori
,nasie testing
- Rapid urease test
- $istology - "ulture
%on inasie testing
- serology - urea breath test
- stool antigen
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"linical eatures o PUD
:pigastric pain
35 2 o patients /ith %S+,D inducedulcer present /ith a complication oPUD /ithout preceding symptoms opain
%ausea
;eight loss in U
&n examination epigastrictenderness is oten present
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"omplications o PUD
astrointestinal bleeding
Peroration
astric outlet obstruction
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,nestigations
Diagnosis o PUD
- arium study
- :ndoscopy * most sensitie andspecifc
procedure
,mportant to distinguish malignantrom benign U and perorming agastic biopsy is useul or thisur ose
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reatment
reatment o PUD may be medical orsurgical
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reatment ( medical )
+cid neutrali
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$. Pylori eradicationtreatment
Single drug therapy not e>ectie
#ulti drug regimes are used /hichcontains arious combinations o acidinhibitory drugs and antimicrobialdrugs
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Surgical treatment usually or ulcers/hich are reractory to medicaltreatment
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astritis
Gastritisis an in!ammation o thelining o the stomach
,t is a histological diagnosis
,t is not an endoscopic diagnosisunli'e PUD
he reason or this is because thecorrelation bet/een the histologicfndings o gastritis@ the symptomsand the endoscopic fndings is poor
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"auses o gastritis
+cute causes * alcohol@ %S+,DS@ollo/ing surgery@ burns
"hronic causes * $.pylori@autoimmune diseases@ chronic bilere!ux
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"linical eatures
+bdominal pain.
,ndigestion
elching
+bdominal bloating
%ausea and omiting
Pernicious anaemia
7ullness or burning in the upper abdomen "hronic gastritis usuually asymptommatic
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Diagnosis
&ten@ a diagnosis can be made based on thepatientAs description o his or her symptoms@but other methods /hich may be used toeriy gastritis includeB
lood testsBlood cell countPresence o H. pyloriCier@ 'idney@ gallbladder@ or pancreasunctions
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UrinalysisStool sample@ to loo' or blood in
the stool-rays:"s:ndoscopy@ to chec' or stomach
lining in!ammation and mucouserosion
Stomach biopsy@ to test or gastritisandother conditions
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#anagement
+ntacids
Proton pump inhibitors
reatment o the underlying condition eg-eradication o $. pylori
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han' you