Peptic ulcer

A peptic ulcer is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach

1-Pylorus (opening between stomach and (duodenum

2-Duodenum3-Esophagus :occur as a result of the backward

flow of HCl from the stomach into the esophagus

Risk factors people between the ages of 40 and 60 years. After menopause, the incidence of peptic ulcers in women is

almost equal to that in menCauses:1-infection with the gram-negative bacteria H. pylori2-excessive secretion of HCla- stressb- milk and caffeinated beverages,c- smoking, and alcohol

Risk factors

• 3-genetic link is noted in the finding that people with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB

• 4-chronic use of NSAIDs

pathophysiology

The erosion is caused by the:

*increase concentration or activity of acid-pepsin*by decreased resistance of the mucosa

1-a damaged mucosa cannot secrete enough mucus to act as a barrier against HCl.

2-the use of NSAIDs inhibits the secretion of mucusthat protects the mucosa.

:Stress ulceracute mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events such as:

*burns*shock

* severe sepsis*multiple organ traumas

Stress ulcer is common in ventilator-dependentpatients after trauma or surgery.

*endoscopy within 24 hours after injury reveals shallow erosions of the stomach wall by 72 hours, multiple gastric erosions are observed.

*When the patient recover the lesions are reversed.

Pathophysiology of stress ulcer: It preceded by shock; this leads to:

* decreased gastric mucosal blood flow*reflux of duodenal contents into the stomach

*In addition, large quantities of pepsin are released.

*The combination of ischemia, acid, and pepsincreates an ideal climate for ulceration.

Clinical Manifestations*Many people have symptomless ulcers

*in 20% to 30% hemorrhage may occur*pain stimulates the exposed nerve endings.

1-Pain is usually relieved by eating or by taking alkali or by taking antacid

*burning sensation in the midepigastrium*pyrosis (heartburn)

*vomiting*constipation or diarrhea( diet and medications).

*Bleeding 15% of pt’s

Assessment and Diagnostic Findings*physical examination may reveal pain , epigastric

tenderness , abdominal distention.

*endoscopy is the preferred diagnostic procedurebecause itA- allows direct visualization of inflammatory changes, ulcers, and lesionb-It may reveal lesions that are not evident on x-ray studies because of their size or location.

Assessment and Diagnostic Findings Stools may be tested for occult blood*

*H. pylori infection may be determined by biopsy and histology with culture.

*serologic test for antibodies to the H. pylori antigen

*breath test that detects H. pylori*Pain that is relieved by ingesting food or antacids

Medical Management

*medications*lifestyle changes

*Surgical intervention

PHARMACOLOGIC THERAPY:combination of

*Antibiotics*proton pump inhibitors

*bismuth salts

(that suppresses or eradicates H. pylori)

*histamine2 (H2) receptor antagonists and proton pump inhibitors are used to treat NSAID-induced and other ulcers not associated with H. pylori ulcers

:*lifestyle changes

*STRESS REDUCTION AND REST1-The patient may benefit from regular rest periods

during the day, at least during the acute phase of the disease

2-Behavior modification may be helpful.

:*SMOKING CESSATIONStudies have shown that smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum.

Research indicates that continuing to smoke cigarettes may significantly inhibit ulcer repair

DIETARY MODIFICATION

*The goal is to avoid oversecretion of acid.

*Avoid alcohol , coffee.

*Avoid diets rich in milk and cream.

*eating three regular meals a day.

. * avoid ulcerogenic medications(NSAIDs)

SURGICAL MANAGEMENT

*surgery is usually recommended for pt’s who fail to heal after 12 to 16 weeks of medical treatment.

*perforation.

*life-threatening hemorrhage.

*obstruction.

*Patients who need ulcer surgery may have had a long illness.