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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- ",
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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- "&
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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- "/
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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