Pathology of Peptic Ulcer

Pathology of peptic ulcer with its introdution and types

1. PEPTIC ULCER Mujahid Nadeem (13612) Ali Raza (13621) Arslan Tahir (13635) Ansar Ali Raza (13665)

2. CONTENTS INTRODUCTION TYPES ETIOLOGY PATHOGENESIS

3. INTRODUCTION

4. INTRODUCTION Ulcer An ulcer is a discontinuity or break in a bodily membrane that impedes the organ of which that membrane is a part from continuing its normal functions.

5. Types of Ulcers Peptic u lcer Esophageal ulcer Duodenal ulcer Gastric ulcer Pressure ulcer Genital ulcer Ulcerative dermatitis Anal fissure Diabetic foot ulcer

6. Types of Ulcers (Cont.) Corneal ulcer Mouth ulcer Venous ulcer Stress ulcer Ulcerative sarcoidosis Ulcerative lichen planus Ulcerative colitis Ulcerative disposition

7. Peptic Ulcer Also known as “peptic ulcer disease” (PUD) Peptic ulcer is a break in the lining of the stomach, first part of the small intestine, or occasionally the lower esophagus.

8. Sites of peptic ulcer Duodenum …………….…… 80% Stomach …………………….. 19% Duodenum & Stomach ….. 4% GE junction ………………….. Meckel’s diverticulum ……. 1%

9. Occurrence of peptic ulcer Serious medical problem Approx. 500,000 new cases each year 5M people affected in USA only Mostly occur between 55 ot 65 years of age Duodenal ulcer more common in men than women Gastric ulcer more common in women than men

10. Occurrence of peptic ulcer (Cont.) Duodenal ulcers are four times more common than gastric ulcers Mortality rates from peptic ulcer are low High prevalence One of several upper GIT diseases that is caused ,partially, by gastric acid Wide range of symptoms

11. Symptoms Abdominal pain Located in epigastric area Burning in quality Occur on an empty stomach 2-4 hours after meal or at night (nocturnal pain) Relieved by antacids Tend to wax and wane over months

12. Symptoms (Cont.) Perforations Blotting and abdominal fullness Nausea and vomiting Loss of appetite (because of pain) Weight loss Stomach obstruction Heartburn Hematemesis Melena Deep tenderness

13. TYPES OF PEPTIC ULCER

14. Acute Peptic Ulcer Cushing ulcer Curling ulcer Chronic Peptic Ulcer Duodenal ulcer Gastric ulcer Esophageal ulcer Bleeding ulcer Refractory ulcer

15. Acute (Stress) Peptic Ulcer Cushing Ulcer Gastric, duodenal or esophageal ulcer arising in patients with intercranial injury or operation Curling Ulcer Occuring mosty in the proximal duodenum and associated with severe burns and trauma

16. Chronic Peptic Ulcer Gastric Ulcer A gastric ulcer is a sore that is on the inside of the stomach Causes Infection with Helicobecter pylori NSAIDs (e.g. aspirin, ibuprofen, diclofenac )

17. Chronic Peptic Ulcer (Cont.) Duodenal Ulcer The peptic ulcer having a sore on the upper part of small intestine Causes H.pylori Damaging of lining of mucosal wall

18. Chronic Peptic Ulcer (Cont .) Esophageal Ulcer Open sores or lesions in the lining of esophagus Mostly occur in the lower end of esophagus Causes Associated with bad case of chronic gastro esophageal reflux disease or GERD

19. Chronic Peptic Ulcer (Cont.) Bleeding Ulcer Internal bleeding is caused by a peptic ulcer which has been left untreated When this happens it is now referred to as bleeding ulcer Most dangerous type of ulcer

20. Chronic Peptic Ulcer (Cont.) Refractory Ulcer These are simply peptic ulcers that have not healed after at least 3 months of treatment

21. ETIOLOGY OF PEPTIC ULCER

22. What Causes Ulcers? No single cause End result of an imbalance between digestive fluids in stomach and duodenum Most common cause of ulcer is infection with a type of bacteria called Helicobacter pylori ( H.pylori )

23. Factors that can increase the risk of ulcers Use of NSAIDs (such as aspirin, naproxen, ibuprofen and many others prescription medicines; even safety-coated aspirin and aspirin in powder form can cause ulcers Excess acid production from gastrinomas (tumors of acid-producing cells)

24. Factors that can increase the risk of ulcers (Cont.) Excessive drinking Smoking or chewing tobacco Serious illness Radiation treatment of the area

25. Who is more likely to get ulcers? Those people are more like to get ulcers who: Are infected with H.pylori Take NSAIDs (aspirin, ibuprofen or naproxen etc.) Have a family history of ulcers Have another illness such as liver, kidney or lung disease Drink regularly Are age 50 or older

26. How are ulcers treated? If not properly treated, they can lead to serious health problems Ulcers can be treated by following ways: Lifestyle changes Medication Surgery

27. Lifestyle changes Eliminate substrate that can causing ulcers Stop drinking and/or smoking Stop using NSAIDs

28. Ulcer Medication Proton Pump Inhibitors(PPIs) Reduce acid level and allow ulcer to heal These include: D exlansoprazole , Esomeprazole Lansoprazole Omeprazole Pantoprazole Rabeprazole O meprazole/sodium bicarbonate etc.

29. Ulcer Medication (Cont.) Antibiotics Used for H.pylori induced ulcers Multiple combinations of antibiotics are used Taken for 2-3 weeks along with PPIs

30. Ulcer Medication Upper Endoscopy Bleeding ulcers can be treated using an endoscope

31. Surgery Surgery is needed if: U lcer creates a hole in the wall of stomach There is serious bleeding that cannot be controlled with an endoscope

32. How to reduce the risk of developing ulcers? Don’t smoke Don’t drink Don’t overuse aspirin or NSAIDs If you have symptoms of ulcer, contact your health care provider

33. PATHOGENESIS OF PEPTIC ULCER

34. H.pylori INDUCED ULCER Gram negative bacteria produced heat shock proteins Cytokines , histamine, lipopolysaccharides, certain enzymes Phospholipase U rease, protease, fucosidase etc. Urease convert in acidic media urea into ammonia and carbon dioxide. Ammonia itself cause destruction of mucosal lining.

35. Ammonia cause infection of mucosal lining and ultimately inflammatory mediators release. Cytokines L eukocytes adhesion and inflammatory reactions starts Damage mucosa of GIT Ulcer occurs

36. DRUG INDUCED ULCER Drugs for example NSAIDS as aspirin(non selectively inhibit cox1 and cox2 in human body Arachidonic acid cox1,2 Prostaglandins C ontrols gastric juice secretions Damage mucosal lining lead to ulcer

37. STRESS INDUCED ULCER In stress energy consumption increase so increase glycolysis which is usually done by cortisol hormone This hormone inhibit phospholipase A2 N o arachidonic acid formation no prostaglandin increase gastric juice secretions Cause ulcer

38. STEROIDS INDUCED ULCER Steroids acts on cell membrane (phospholipid) Inhibit phospholipase Inhibits arachidonic acid no prostaglandins and damaging of mucosal lining

39. ULCER DUE TO GENETIC DEFECT Rare genetics occurs some time having blood group O positive the size of parietal cell is increase Increase cell demand as HCL secretions increase C ause destruction of mucosal lining leading towards ulcer

40. ZES( Zollinger -Ellison Syndrome) In this syndrome tumor of goblet cell occurs Abnormal mucus secretions(gastrin acts on parietal cells) I ncrease secretions of gastric juice Mucosal lining damage

41. THANK YOU 