Peptic ulcer

Peptic Ulcer

1. Peptic Ulcer Hawler Medical University College of Medicine Community Health Prepared by: Hawraz Faris Saadi BSN, MD Student 11/21/2017 1

2. Peptic Ulcer Is a break in the lining of the stomach , first part of the small intestine or occasionally the lower esophagus. Peptic ulcers are produced by an imbalance between the gastroduodenal mucosal defense mechanisms and damaging forces of gastric acid and pepsin, combined with superimposed injury from environmental or immunologic agents 11/21/2017 2

3. Peptic Ulcer Cont. Contrary to general belief, more peptic ulcers arise in the duodenum than in the gastric, four times more common than gastric ulcers Duodenal ulcers usually first occur between the ages of 30-50 years and are twice as common in men as in women. Gastric ulcers usually occur in people older than 60 years and are more common in women. 11/21/2017 3

4. 11/21/2017 4

5. Calcification : Esophagus (called esophageal ulcer) Stomach (called gastric ulcer ) Duodenum (called duodenal ulcer) 11/21/2017 5

6. Symptoms Duodenal ulcer burning, aching, or hunger-like pain, primarily in the upper middle region of the abdomen below the breastbone (the epigastric region). Pain may occur or worsen when the stomach is empty, usually two to five hours after a meal. Symptoms may occur at night between 11 PM and 2 AM, when acid secretion tends to be greatest. Feel better when you eat or drink and then worse 1 or 2 hours later (duodenal ulcer) 11/21/2017 6

7. Symptoms Cont. Gastric ulcer pain soon after eating. Symptoms are sometimes not relieved by eating or taking antacids. Feel worse when you eat or drink. 11/21/2017 7

8. Causes Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine or backward to the esophagus. The acid can create a painful open sore that may bleed. 11/21/2017 8

9. Causes Bacterium Regular use of certain pain relievers (NSAIDs) 11/21/2017 9

10. Causes Cont. A bacterium . Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine . Often, the H. pylori bacterium causes no problems, but it can cause inflammation of the stomach's inner layer, producing an ulcer. 11/21/2017 10

11. Causes Cont. A bacterium : It's not clear how H. pylori infection spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water. 11/21/2017 11

12. Causes Cont. Regular use of certain pain relievers . NSAIDs inhibit production of an enzyme ( cyclooxygenase) that produces prostaglandins. These hormone-like substances help protect stomach lining from chemical and physical injury. Without this protection, stomach acid can erode the lining, causing bleeding and ulcers 11/21/2017 12

13. Risk factors Smoke . Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori. Increased rate of gastric emptying Diminished pancreatic bicarbonate secretion Decreased duodenal pH Reduced mucosal blood flow Inhibition of mucosal prostaglandins 11/21/2017 13

14. Risk factors Drink alcohol . Alcohol can irritate and erode the mucous lining of the stomach , and it increases the amount of stomach acid that's produced. Have untreated stress . Eat spicy foods . Caffeine. 11/21/2017 14

15. Test and diagnosis Noninvasive Urea Breath Test (UBT) Blood test Invasive Histology Biopsy Urease Test 11/21/2017 15

16. Complications Internal bleeding . Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools. 11/21/2017 16

17. Complications Cont. Infection . Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis). 11/21/2017 17

18. Complications Cont. Obstruction . Peptic ulcers can lead to swelling, inflammation or scarring that may block passage of food through the digestive tract. A blockage may make you become full easily, vomit and lose weight. 11/21/2017 18

19. Goals of treatment Lowering the amount of acid that stomach makes, Neutralizing the acid Protecting the injured area so it can heal It's also very important to stop smoking and drinking alcohol Prevent complications (bleeding, perforation, penetration, obstruction ) Minimize recurrences Reduce financial costs 11/21/2017 19

20. Treatment Antibiotic medications Acid blockers 11/21/2017 20

21. Primary prevention Health education about the diseases, causes, risk factors, and how prevent it. Avoid tobacco products. Avoid alcohol. Use caution with aspirin and/or NSAIDs. Protect yourself from infections by washing hands regularly and consuming foods that have been cooked thoroughly 11/21/2017 21

22. Secondary prevention Screening and early diagnosis is very important to treating and prevent complications. While avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) and cigarette smoking may decrease the risk of recurrence, the role of alcohol intake is less certain. Nonetheless , avoidance of excessive alcohol intake is usually recommended 11/21/2017 22

23. 11/21/2017 23