4. INTRODUCTION
Ulcer
ī§ 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
īąPeptic ulcer
i. Esophageal ulcer
ii. Duodenal ulcer
iii. Gastric ulcer
īąPressure ulcer
īąGenital ulcer
īąUlcerative dermatitis
īąAnal fissure
īąDiabetic foot ulcer
7. Peptic Ulcer
ī§ Also known as âpeptic ulcer diseaseâ (PUD)
ī§ Peptic ulcer is a break in the lining of the
stomach, first part of the small intestine, or
occasionally the lower esophagus.
12. Occurrence of peptic ulcer
ī§ Serious medical problem
ī§ Approx. 500,000 new cases each year
ī§ 5M people affected in USA only
ī§ Mostly occur between 55 ot 65 years of age
ī§ Duodenal ulcer more common in men than
women
ī§ Gastric ulcer more common in women than
men
13. Occurrence of peptic ulcer
(Cont.)
ī§ Duodenal ulcers are four times more
common than gastric ulcers
ī§ Mortality rates from peptic ulcer are low
ī§ High prevalence
ī§ One of several upper GIT diseases that is
caused ,partially, by gastric acid
ī§ Wide range of symptoms
14. Symptoms
īļAbdominal pain
âĸ Located in epigastric area
âĸ Burning in quality
âĸ Occur on an empty stomach 2-4 hours after
meal or at night (nocturnal pain)
âĸ Relieved by antacids
âĸ Tend to wax and wane over months
15. Symptoms (Cont.)
īļPerforations
īļBlotting and abdominal fullness
īļNausea and vomiting
īļLoss of appetite (because of pain)
īļWeight loss
īļStomach obstruction
īļHeartburn
īļHematemesis
īļMelena
īļDeep tenderness
17. īļAcute Peptic Ulcer
a. Cushing ulcer
b. Curling ulcer
īļChronic Peptic Ulcer
a. Duodenal ulcer
b. Gastric ulcer
c. Esophageal ulcer
d. Bleeding ulcer
e. Refractory ulcer
18. 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
19.
20. Chronic Peptic Ulcer
Gastric Ulcer
A gastric ulcer is a sore that is on the inside of
the stomach
Causes
ī§ Infection with Helicobecter pylori
ī§ NSAIDs (e.g. aspirin, ibuprofen, diclofenac)
21. Chronic Peptic Ulcer (Cont.)
Duodenal Ulcer
The peptic ulcer having a sore on the upper part
of small intestine
Causes
ī§ H.pylori
ī§ Damaging of lining of mucosal wall
22.
23. Chronic Peptic Ulcer (Cont.)
Esophageal Ulcer
ī§ Open sores or lesions in the lining of
esophagus
ī§ Mostly occur in the lower end of esophagus
Causes
ī§ Associated with bad case of chronic gastro
esophageal reflux disease or GERD
24.
25. Chronic Peptic Ulcer (Cont.)
Bleeding Ulcer
ī§ Internal bleeding is caused by a peptic ulcer
which has been left untreated
ī§ When this happens it is now referred to as
bleeding ulcer
ī§ Most dangerous type of ulcer
26.
27. Chronic Peptic Ulcer (Cont.)
Refractory Ulcer
These are simply peptic ulcers that have not
healed after at least 3 months of treatment
29. What Causes Ulcers?
ī§ No single cause
ī§ End result of an imbalance between digestive
fluids in stomach and duodenum
ī§ Most common cause of ulcer is infection with
a type of bacteria called Helicobacter pylori
(H.pylori)
30. Factors that can increase
the risk of ulcers
ī§ 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
ī§ Excess acid production from gastrinomas
(tumors of acid-producing cells)
31. Factors that can increase
the risk of ulcers (Cont.)
ī§ Excessive drinking
ī§ Smoking or chewing tobacco
ī§ Serious illness
ī§ Radiation treatment of the area
32. Who is more likely to get
ulcers?
Those people are more like to get ulcers who:
ī§ Are infected with H.pylori
ī§ Take NSAIDs (aspirin, ibuprofen or naproxen
etc.)
ī§ Have a family history of ulcers
ī§ Have another illness such as liver, kidney or lung
disease
ī§ Drink regularly
Are age 50 or older
33. How are ulcers treated?
īļIf not properly treated, they can lead to
serious health problems
īļUlcers can be treated by following ways:
ī§ Lifestyle changes
ī§ Medication
ī§ Surgery
38. Surgery
Surgery is needed if:
ī§ Ulcer creates a hole in the wall of stomach
ī§ There is serious bleeding that cannot be
controlled with an endoscope
39. How to reduce the risk of
developing ulcers?
ī§ Donât smoke
ī§ Donât drink
ī§ Donât overuse aspirin or NSAIDs
ī§ If you have symptoms of ulcer, contact your
health care provider
41. H.pylori INDUCED ULCER
Gram negative bacteria produced heat shock proteins
Cytokines, histamine, lipopolysaccharides, certain
enzymes
Phospholipase
Urease, protease, fucosidase etc.
ī§ Urease convert in acidic media urea into ammonia
and carbon dioxide. Ammonia itself cause
destruction of mucosal lining.
42. ī Ammonia cause infection of mucosal lining and
ultimately inflammatory mediators release.
ī Cytokines Leukocytes adhesion and
inflammatory reactions starts
Damage mucosa of GIT
Ulcer occurs
43.
44. DRUG INDUCED ULCER
Drugs for example NSAIDS as aspirin(non
selectively inhibit cox1 and cox2 in human body
Arachidonic acid cox1,2 Prostaglandins
Controls gastric juice secretions
Damage mucosal lining lead to ulcer
45. STRESS INDUCED ULCER
In stress energy consumption increase so increase
glycolysis which is usually done by cortisol hormone
This hormone inhibit phospholipase A2
No arachidonic acid formation no prostaglandin
increase gastric juice secretions
Cause ulcer
46. STEROIDS INDUCED ULCER
Steroids acts on cell membrane (phospholipid)
Inhibit phospholipase
Inhibits arachidonic acid no prostaglandins and
damaging of mucosal lining
47. 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
Cause destruction of mucosal lining leading
towards ulcer
48. ZES(Zollinger-Ellison
Syndrome)
In this syndrome tumor of goblet cell occurs
Abnormal mucus secretions(gastrin acts on
parietal cells)
Increase secretions of gastric juice
Mucosal lining damage