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8/9/2019 PudH GYGUG YGYGY GYG

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Peptic Ulcer Disease

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Peptic Ulcer Disease

Condition characterized by

Erosion of GI mucosa resulting from

digestive action of HCl and pepsin

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Peptic Ulcer Disease

Ulcer development

Loer esophagus

!tomachDuodenum

"#$ of men% &$ of omen

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'ypes

(cute

!uperficial erosion

)inimal erosionChronic

)uscular all erosion ith formation

of fibrous tissuePresent continuously for many months

or intermittently

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Peptic Ulcer Disease Etiology and Pathophysiology

 

Develop only in presence of acidenvironment

E*cess of gastric acid not necessary for

ulcer developmentPerson ith a gastric ulcer has normal to

less than normal gastric acidity

compared ith person ith a duodenalulcer

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Peptic Ulcer Disease Etiology and Pathophysiology

 

!ome intraluminal acid does seem to be

essential for a gastric ulcer to occur

Pepsinogen is activated to pepsin in

presence of HCl and a pH of + to ,

!ecretion of HCl by parietal cells has a

pH of #-.

pH reaches + to , after mi*ing ith

stomach contents

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Peptic Ulcer Disease Etiology and Pathophysiology

 

)ucosal barrier prevents bac0 diffusion

of acid from gastric lumen through

mucosal layers to underlying tissue

)ucosal barrier can be impaired and

bac0 diffusion can occur

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1ac02Diffusion of (cids 

3ig- &#2",

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Peptic Ulcer Disease Etiology and Pathophysiology

 

HCl freely enters mucosa hen barrier is

bro0en

In4ury to tissue occurs

5esult6 cellular destruction and

inflammation

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Peptic Ulcer Disease Etiology and Pathophysiology

 

Ulcerogenic drugs inhibit synthesis of

prostaglandins and cause abnormal

permeability

Corticosteroids 9 rate of mucosal cell

reneal thereby 9 protective effects

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Disruption of Gastric )ucosal 1arrier

3ig- &#2"&

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Peptic Ulcer Disease Etiology and Pathophysiology

 

:hen blood flo is not sufficient% tissue

in4ury results

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Peptic Ulcer Disease Etiology and Pathophysiology

 

'o mechanisms that protect

)ucus forms a layer that entraps or

slos diffusion of hydrogen ions across

mucosal barrier

1icarbonate is secreted;eutralizes HCl acid in lumen of GI tract

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Peptic Ulcer Disease Etiology and Pathophysiology

 

8 7agal nerve stimulation results in

hypersecretion of HCl acid

8 HCl acid can alter mucosal barrier

Duodenal ulcers are associated ith 8

acid

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Gastric Ulcers

Commonly found on lesser curvature in

close pro*imity to antral 4unction

Less common than duodenal ulcers

Prevalent in omen% older adults%

persons from loer socioeconomic

class

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Gastric Ulcers

Characterized by

( normal to lo secretion of gastric

acid

1ac0 diffusion of acid is greater

<chronic=

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Gastric Ulcers

Critical pathologic process is amount of

acid able to penetrate mucosal barrier

 H. pylori  is present in /#$ to >#$

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Gastric Ulcers

 H. pylori  is thought to be moredestructive hen no*ious agents areused% or patient smo0es

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Gastric Ulcers

Drugs can cause acute gastric ulcers(spirin% corticosteroids% ;!(IDs%

reserpine

?r 0non causative factorsChronic alcohol abuse% chronic gastritis

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Duodenal Ulcers

?ccur at any age and in anyone

8 1eteen ages of ,/ to &/ years

(ccount for @.#$ of all peptic ulcers

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Duodenal Ulcers

(ssociated ith 8 HCl acid secretion

 H. pylori  is found in A#2A/$ of patientsDirect relationship has not been found

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Duodenal Ulcers

Diseases ith 8 ris0 of duodenal ulcers

C?PD% cirrhosis of liver% chronic

pancreatitis% hyperparathyroidism%

chronic renal failure

'reatments used for these conditions may

promote ulcer development

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Psychological !tress Ulcers

(cute ulcers that develop folloing a

ma4or physiologic insult such as trauma

or surgery

( form of erosive gastritis

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Psychological !tress Ulcers

Ischemia due to 9 capillary blood flo or

shunting of blood aay from GI tract so

that blood flo bypasses gastric mucosa

Imbalance beteen destructive

properties of HCl acid and pepsin% and

protective factors of stomachBs

mucosal barrier

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Peptic Ulcer DiseaseClinical Manifestations 

Common to have no pain or othersymptomsGastric and duodenal mucosa not rich

in sensory pain fibersDuodenal ulcer pain

1urning% crampli0e

Gastric ulcer pain1urning% gaseous

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Peptic Ulcer DiseaseComplications

 

, ma4or complications

Hemorrhage

PerforationGastric outlet obstruction

Initially treated conservatively

)ay reuire surgery at any time duringcourse of therapy

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Peptic Ulcer Disease Hemorrhage

)ost common complication of peptic

ulcer disease

Develops from erosion of

Granulation tissue found at base of

ulcer during healing

Ulcer through a ma4or blood vessel

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Peptic Ulcer Disease Perforation

 

)ost lethal complication of peptic ulcer

Commonly seen in large penetratingduodenal ulcers that have not healed andare located on posterior mucosal all

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Peptic Ulcer Disease Perforation

 

Perforated gastric ulcers often located onlesser curvature of stomach

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Peptic Ulcer Disease

 Perforation 

3ig- &#2"/

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Peptic Ulcer Disease Perforation

 

?ccurs hen ulcer penetrates serosalsurface!pillage of their gastric or duodenal

contents into peritoneal cavity!ize of perforation directly proportional

to length of time patient has had ulcer

!udden% dramatic onset

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Peptic Ulcer DiseaseGastric Outlet Obstruction

Ulcers located in antrum and prepyloricand pyloric areas of stomach

Duodenum can predispose to gastric

outlet obstruction 8 contractile force needed to empty

stomach results in hypertrophy of

stomach all

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Peptic Ulcer DiseaseGastric Outlet Obstruction

(fter longstanding obstruction stomachenters decompensated phase

5esults in dilation and atony

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Peptic Ulcer DiseaseGastric Outlet Obstruction

?bstruction is not totally due to fibrousscar tissue(ctive ulcer formation is associated

ith edema% inflammation%pylorospasm

(ll contribute to narroing of pylorus

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Peptic Ulcer DiseaseGastric Outlet Obstruction

Usually has a history of ulcer pain

!hort duration or absence of pain

indicative of a malignant obstruction

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Peptic Ulcer DiseaseGastric Outlet Obstruction

7omiting is common

Constipation is a common complaint

Dehydration% lac0 of roughage in diet

)ay sho selling in upper abdomen

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Peptic Ulcer Disease Diagnostic Studies

 

Endoscopy procedure most often used

Determines degree of ulcer healing

after treatment

'issue specimens can be obtained to

identify H. pylori  and to rule out

gastric cancer

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Peptic Ulcer Disease Diagnostic Studies

 

Gastric analysis

Identifying a possible gastrinoma

Determining degree of gastric

hyperacidity

Evaluating results of therapy

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Peptic Ulcer Disease Diagnostic Studies

 

Laboratory analysis

C1C

Urinalysis

Liver enzyme studies

!erum amylase determination

!tool e*amination

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