Peptic ulcer disease

PEPTIC ULCER DISEASE --Dr. Mansi

What is PEPTIC ULCER????? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SITES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathomorphology ,[object Object],[object Object],[object Object],Margins – Perpendicular - No Elevatn or Beading Mild oedema of immediate adj. mucosa Surrounding Mucosal folds Radiate like Wheel Spokes Base Remarkably Clean

Duodenal ulcer Gastric ulcer Patho physiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],increasd decreased rapid delayed Bicarbonate secretion remarkably decreased H.pylori & NSAID H.pylori & NSAID Abnormal resting & stimulated Pyloric sphincter pressure

ETIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pathogenetic factors not related to h.pylori & NSAID

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],H.pylori

Cytokines-IL 1 α / β , IL6,IL2, IL8(recruits act. neutrophils) TNF- α ,IFN- γ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cagA into host cells ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],V I R U L E N C E Pathophysiology of H.pylori ulcer

[object Object],[object Object],[object Object],Then how does it cause Ulcers in duodenum?????

[object Object],[object Object],Direct toxicity by Ion trapping ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ULCER erosions Healing (spontaneous Or therapeutic) NSAID induced PUD Pathophysiology Epithelial effects Due to PG depletion

Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Symptom : sudden continuous generalized abd pain Examn : severly tender board like abdomen Common in elderly and with NSAID Penetration Complications Symptoms : Pain worsening with meals, nausea and vomiting of undigested food Examn : succusion splash Symptoms : Tarry stools or coffee ground emesis Acute hematemesis Anemia Examn : tachycardia and orthostasis suggesting dehydration

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Differential diagnosis

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Non invasive: serology Urea breath test Stool antigen Invasive : rapid urease histology culture Duodenal ulcer Gastric ulcer

[object Object],[object Object],[object Object],[object Object],: Magnesium Hydroxide ,Aluminum Hydroxide , Sodium Bicarbonate , Calcium Carbonate :100 – 150 meq/l 1 & 3 hrs after the meal & hs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],-Sucralfate – 1gm qid -Misoprostol - 200 μ g qid

Regimens for Eradication Of H.Pylori ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Regimens for Eradication Of H.Pylori 3. Omeprazole + - 20mg bid Claithromycin + -250/500mg bid Metronidazole / -500mg bid Amoxicillin - 1gm bid

[object Object],[object Object],[object Object],[object Object]

Surgical Therapy ,[object Object],[object Object],[object Object],[object Object]

Surgical Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Peptic ulcer disease

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